Surgical retractor

ABSTRACT

A surgical retractor and a method of minimally invasive surgery, wherein the surgical retractor includes ribs and a mechanism for transferring of linear and rotational movements of the ribs and wherein each rib can be easily replaced without use of any additional tools. According to embodiments of the present invention, specific parts composing the surgical retractor are made of materials transparent to Röntgen rays (x-rays).

REFERENCE TO CROSS-RELATED APPLICATION

This application is a Continuation-in-Part of U.S. patent applicationSer. No. 12/880,162, filed on Sep. 13, 2010, which is aContinuation-in-Part of U.S. patent application Ser. No. 12/814,492,filed on Jun. 14, 2010, which claims priority from U.S. ProvisionalPatent Application No. 61/307,469, filed on Feb. 24, 2010.

This application claims priority benefits from U.S. patent applicationSer. No. 12/880,162, filed on Sep. 13, 2010, herein incorporated byreference in its entirety, which claims priority from U.S. patentapplication Ser. No. 12/814,492, filed on Jun. 14, 2010, hereinincorporated by reference in its entirety, which claims priority fromU.S. Provisional Application No. 61/307,469, filed on Feb. 24, 2010,herein incorporated by reference in its entirety

FIELD OF THE INVENTION

The present invention relates to apparatus and techniques for performingminimally invasive surgery and, in particular to a retractor device forminimally invasive surgery, more particularly to a new expandingretractor for spinal minimal invasive neurosurgery.

BACKGROUND OF THE INVENTION

A concentrically expansible needle retractor for minimally invasivesurgery, of one the present inventors, is described in PCT/IL2000/00387,filed Jul. 4, 2000, the full disclosures of which are incorporatedherein by reference.

An improved radial expansible retractor for minimally invasive surgery,of the present inventors, is described in PCT/IL2006/001250, filed Oct.30, 2006, which has significant improvements which can benefit patients,the full disclosures of which are incorporated herein by reference.

FIG. 1 a of the prior art is a perspective view schematic illustrationof the improved radial expansible retractor, which will be referred toin the present application as a prior art radial expansible retractor(PARER) 100.

The illustrations show PARER ribs 141 touching each other, forming ahollow cylinder.

The prior art radial expansible retractor 100 is equipped with a PARERadaptor 169 and with a mechanism for transmitting gentle rotationalmechanical movement from a PARER rotating wheel 161 to a PARER grooveddisc 152, (not shown in the present illustrations).

FIG. 1 b of the prior art is a perspective view schematic illustrationof a PARER cover 151, of the prior art radial expansible retractor, inwhose center is a PARER cover central perforation 151 a of a suitablediameter for inserting a tubule and performing the medical procedure.

FIG. 1 c of the prior art is a perspective view schematic illustrationof a PARER grooved disc 152, of the prior art radial expansibleretractor, in whose center is a PARER grooved disc central perforation152 a, of a suitable diameter for inserting the tubule and performingthe medical procedure, and PARER grooves 152 b, in the present caseeight, designated to grant continuous forced movement to rib carrierpins.

In the case of need to open a shape other than a circle, the PARERgrooved disc 152 can be used with at least part of the grooves having adifferent curve, and ends at different distances from the center. Thisdifference necessarily results in different movement of each of theribs, forming a lateral section, which is not circular.

Namely, the desired opening shape to be achieved by means of prior artradial expansible retractor must be determined prior to commencement ofthe medical operation.

FIG. 1 d of the prior art is a perspective view schematic illustrationof a of PARER channeled disc 153, of the prior art radial expansibleretractor 100, in whose center is a PARER channeled disc centralperforation 153 a, of a suitable diameter for inserting the tubule andperforming the medical procedure, and PARER channels 153 b, in thepresent case eight, designated to grant continuous forced movement tothe rib carrier (not shown in the present figure). The PARER channels153 b are completely straight, and are pointed in the directions of theradiuses from a joint center of the PARER channeled disc 153. Theirdimensions conform to those of rib carrier, and they are designated toenable strictly radial movement of PARER rib carrier 144 with regard tothe aforementioned center.

Combination of the PARER channeled disc 153 and the PARER cover 151 isdone by means of geometrically conforming both to each other, togetherforming a casing suitable for carrying PARER grooved disc 152 andgranting it smooth rotational movement.

FIG. 1 e of the prior art is lateral section schematic illustrations ofthe prior art radial expansible retractor.

The figure clearly showing PARER rib carrier 144 disposed within PARERchannel 153 b of the PARER channeled disc 153, with a PARER rib carrierpin 145 disposed within PARER groove 152 b of the PARER grooved disc152. The PARER rib carrier 144 connects to PARER rib base 142, which isthe integral base of PARER rib 141, by means of PARER rib carrier bolt147.

FIG. 1 f of the prior art is a perspective view schematic illustrationof a PARER rib 141 of the prior art radial expansible retractor.

At one end of PARER rib 141, the PARER rib's base 142 is disposed, intowhich the PARER rib base hole 143 is perforated. PARER rib 141 is formedas an elongated rod whose cross section can have many variousgeometrical shapes, also including the shape of a section of the wall ofa cylinder.

FIG. 1 g of the prior art is a perspective view schematic illustrationof a PARER rib carrier 144 of the prior art radial expansible retractor.Its shape conforms for connection to the PARER rib's base 142 and itincludes PARER rib carrier hole 146, and PARER rib carrier pin 145.

As far as minimal invasive methods of treatment of spinal stenosis areconcerned, they are commonly performed with the assistance of tubularretractors.

A tubular retractor for minimally invasive surgery, of Bartie et al., isdescribed in U.S. Pat. No. 6,210,325, granted Apr. 3, 2001, the fulldisclosures of which are incorporated herein by reference.

Use of tubular retractors for the performance of treatment of spinalstenosis has some very grave drawbacks, also including:

Over traumatization (disruption of muscles and nerves roots) of softtissues upon insertion of a retractor, in most cases hammering isrequired to insert the retractor between muscle fibrils, resulting indestruction and disruption of soft tissues. During postoperativerecovery, this kind of iatrogenic damage can inflict pain more severethan that caused by the pathology itself.

The tubular retractor frequently causes postoperative hemorrhaging andcompression of the spinal cord, with motor function deterioration of thepatient's extremities.

Uncontrolled soft tissue retraction (without measurement of retractedtissue pressure (RTP) and retracted tissue oxygen saturation (RTOS))causes ischemic muscular degeneration-IMD and development of extremelyrough postoperative scar tissue, resulting in circular compression ofnerve roots and thus severe postoperative pain.

Very fast insertion of such tubular retractors causes splitting ofmuscles from vertebral bones and hemorrhaging. Surgeons must be awarethat even though the surgery is completed effectively in a narrow space,symptoms can occur immediately if even a small hematoma is generated inthis space.

Appropriate surgical tools and manual skills are required since surgeonsmust work in a narrow space. Further, there may be confusion regardinganatomical structures in such a limited space. Another problem is thelimitations of effective decompression due to limited and constant(unchangeable, non-adjustable) diameters of tubular retractors.

Due to differing curvatures of vertebral lamina, tubular retractorsdon't enable the surgeon to approach lateral parts of lamina, includingvertebral facets, and vision may be obstructed or disrupted by the useof tools in a narrow space with limited light.

Non-simultaneous unidirectional retraction of muscles causes unevendistribution of pressure to the soft tissues. Uncontrolled soft tissueretraction (without measurement of retracted tissue pressure (RTP) andretracted tissue oxygen saturation (RTOS)) causes ischemic musculardegeneration (IMD), and development of extremely rough postoperativescar tissue, resulting in circular compression of nerve roots and thussevere postoperative pain.

There is thus a widely recognized need for, and it would be highlyadvantageous to have, a surgical retractor for performing minimallyinvasive surgery, that will not have the aforementioned drawbacks, thatwill also enable working with massive tissue pressures to the extentthat body tissues can apply, that will enable creating openings ofvarious section shapes which can be changed in the course of operation,and that will be equipped with ribs of various shapes and sizes, thatcan be easily replaced without use of additional tools.

SUMMARY OF THE INVENTION

The surgical retractor according to the present invention furtherimproves the performance currently available with the prior art. Itenables creating openings in the human body in locations in which thetissue pressure on its ribs is significantly more powerful than in brainsurgery, such as in operations in close proximity with to the spine,with the ribs of the surgical retractor subject to pressure of theadjacent muscles. An additional improvement is enabling the option ofdetermining the shape of the opening in the operated body created by thesurgical retractor when opening, and even changing the shape asnecessary throughout the operation. This is achieved by a combination ofopening all ribs of the surgical retractor simultaneously as a circleand subsequent individual control of each separate rib's inclinationangle. Another major improvement is in enabling the replacement, priorto commencement of use of the surgical retractor, of the ribs of thesurgical retractor without any need for any additional tools.

Yet another significant improvement is the addition of a light source tothe surgical retractor, which grants the operating surgeon highvisibility of the working area.

The surgical retractor can also be added a flexible sleeve, made forexample of rubber or silicone, to prevent entry of surrounding tissueinto the working channel.

Yet another significant improvement, according to embodiments of thepresent invention, is that some of the components of the surgicalretractor are made of materials transparent to Röntgen rays (x-rays).

According to the teachings of the present invention there is provided asurgical retractor, including: a ribs assembly; a mechanism fortransferring of linear and rotational movement adapted to applymechanical forces and moments to the ribs assembly; and a channeled discwherein the mechanism for transferring of linear and rotational movementand the ribs assembly are mounted on the channeled disc.

According to another further teaching of the present invention thechanneled disc is made of material selected from a group consisting ofnylon and polycarbonate.

According to another further teaching of the present invention the ribsassembly includes: at least two ribs, wherein each one of the ribs has arib force arm and a rib working arm disposed on the rib force arm,wherein the rib has a rib back surface, a rib front surface, a rib topend, a rib bottom end, a rib top end, a rib bottom end and a ribshoulder, wherein the rib shoulder is disposed on the force arm, whereinthe rib force arm has a rib force arm length and a rib force arm width,wherein the rib force arm width tapers toward the rib top end, whereinthe rib working arm has a rib working arm length and a rib working armwidth, wherein the rib working arm width tapers toward the rib bottomend wherein the rib has a concave segment of a rib front surface, theconcave segment of a rib front surface having a concave segment of a ribfront surface diameter.

According to another further teaching of the present invention the ribsare made of material containing nylon and carbon fibers.

According to another further teaching of the present invention the ribsare made of stainless steel.

According to another further teaching of the present invention at leastone of the rib working arms' length is larger than at least another oneof the rib working arms' length.

According to another further teaching of the present invention thechanneled disc includes: at least two channels.

According to another further teaching of the present invention themechanism for transferring of linear and rotational movement includes:at least two main sliders, wherein each one of the main sliders has amain slider upper portion having an upper portion length, a main slidermid portion, having a mid portion length wherein the main slider midportion is disposed on the main slider upper portion, and a main sliderlower portion, having a lower portion length, wherein the main sliderlower portion is disposed on the main slider mid portion, wherein theupper portion length is larger than the mid portion length, wherein thelower portion length is larger than the upper portion length, andwherein each of the main slider lower portion is partially mountedinside one of the channels.

According to another further teaching of the present invention each ofthe main sliders includes: a pair of slider arms disposed on the mainslider lower portion; and a slider pivot disposed on the pair of sliderarms, wherein the main slider lower portion has a slider among armssurface and wherein there is a gap between the slider pivot and theslider among arms surface having a predetermined dimension value, andwherein the slider pivot is adapted for transferring force to theconcave segment of a rib front surface.

According to another further teaching of the present invention the mainslider has a first interior thread located in the main slider upperportion.

According to another further teaching of the present invention themechanism for transferring of linear and rotational movement furtherincludes: at least two angular adjustment bolts wherein each of theangular adjustment bolts is mounted inside the one of the first interiorthread and is adapted for transferring force to one of the rib forcearms.

According to another further teaching of the present invention the mainslider has a second interior thread located in the main slider midportion.

According to another further teaching of the present invention themechanism for transferring of linear and rotational movement furtherincludes: at least two linear adjustment bolts wherein each of thelinear adjustment bolts is mounted inside one of the second interiorthreads.

According to another further teaching of the present invention thesurgical retractor further including: an opening mechanism first type,wherein the opening mechanism first type is adapted for engaging to themain sliders for performing linear opening and wherein the openingmechanism first type is adapted for removing from the main sliders at anoperation stage.

According to another further teaching of the present invention theopening mechanism first type includes: an opening mechanism base havingat least two opening mechanism base grooves, and at least four openingmechanism base tracks; an opening mechanism pole disposed on the openingmechanism base; opening mechanism arms ring, having at least two pairsof opening mechanism arms ring arms, wherein the opening mechanism armsring has opening mechanism arms ring central hole, and wherein theopening mechanism arms ring is mounted on the opening mechanism pole; atleast two opening mechanism arms; at least two opening mechanismsliders; at least four opening mechanism arm upper pivots; and at leastfour opening mechanism arm lower pivots, wherein each one of the openingmechanism arm upper pivot is disposed on one of the pairs of openingmechanism arms ring arms, wherein each one of the opening mechanism armlower pivots is disposed on one of the opening mechanism sliders,wherein the each one of the opening mechanism arms is mounted on theopening mechanism arm upper pivot and on one of the opening mechanismarm lower pivots.

According to another further teaching of the present invention thesurgical retractor further includes: an opening mechanism second type,wherein the opening mechanism second type is adapted for engaging to themain sliders for performing linear opening and wherein the openingmechanism first type is adapted for removing from the main sliders at anoperation stage.

According to still another further teaching of the present invention theopening mechanism second type includes: an opening mechanism base havingat least two opening mechanism base grooves, and at least four openingmechanism base tracks; an opening mechanism cylinder disposed on theopening mechanism base, wherein the opening mechanism cylinder has anopening mechanism cylinder external thread and an opening mechanismcylinder internal diameter; an opening mechanism nut mounted on theopening mechanism cylinder, wherein the opening mechanism cylinder hasan opening mechanism nut internal thread; an opening mechanism armsring, having at least two pairs of opening mechanism arms ring arms,wherein the opening mechanism arms ring has an opening mechanism armsring central hole, and wherein the opening mechanism arms ring ismounted on the opening mechanism cylinder; at least two openingmechanism arms; at least two opening mechanism sliders; at least fouropening mechanism arm upper pivots; and at least four opening mechanismarm lower pivots, wherein each one of the opening mechanism arm upperpivots is disposed on one of the pairs of opening mechanism arms ringarms, wherein each one of the opening mechanism arm lower pivots isdisposed on one of the opening mechanism sliders, and wherein the eachone of the opening mechanism arms is mounted on the opening mechanismarm upper pivot and on one of the opening mechanism arm lower pivots.

According to another further teaching of the present invention each oneof the opening mechanism sliders includes: an opening mechanism sliderupper channel, adapted for enabling a rotational movement of one of theopening mechanism arm; an opening mechanism slider bottom channeladapted for engaging to one of the main sliders; two opening mechanismslider side channels, wherein each one of the opening mechanism sliderside channels is adapted for enabling a linear movement of one of themain sliders on one of the opening mechanism base tracks; and an openingmechanism slider pushing portion adapted for transferring force to oneof the main sliders.

According to another further teaching of the present invention thesurgical retractor further includes: an external disc having at leasttwo external disc stairs, wherein the external disc is mounted on thechanneled disc and partially between each of the main sliders, the mainslider upper portion and the main slider lower portion, wherein theexternal disc is adapted for rotational movement around the channeleddisc, and wherein the external disc stairs are adapted for preventionthe main sliders from movement.

According to another further teaching of the present invention thesurgical retractor further includes: a lighting assembly disposed on thechanneled disc.

According to the teaching of the present invention there is provided amethod of minimally invasive operation for decompression of spinalstenosis, the method including the stages of: inserting a surgicalretractor through a bilateral projection of first bilateral vertebrallamina, wherein the surgical retractor has ribs, a mechanism fortransferring of linear and rotational movements to the ribs, and achanneled disc, wherein the channeled disc is made of material selectedfrom a group consisting of nylon and polycarbonate; moving the ribs inlinear movements; moving at least one of the ribs in a rotationalmovement; incising a first lamina; inserting a wedge for a distractionof the first bilateral vertebral lamina; and replacing at least one ofthe ribs.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is herein described, by way of example only, withreference to the accompanying drawings, wherein:

FIG. 1 a of the prior art is a perspective view schematic illustrationof a prior art radial expansible retractor.

FIG. 1 b of the prior art is a perspective view schematic illustrationof a cover of the prior art radial expansible retractor.

FIG. 1 c of the prior art is a perspective view schematic illustrationof a grooved disc of the prior art radial expansible retractor.

FIG. 1 d of the prior art is a perspective view schematic illustrationof a channeled disc of the prior art radial expansible retractor.

FIG. 1 e of the prior art is lateral section schematic illustrations ofpart of the prior art radial expansible retractor.

FIG. 1 f of the prior art is a perspective view schematic illustrationof a rib of the prior art radial expansible retractor.

FIG. 1 g of the prior art is a perspective view schematic illustrationof a rib carrier of the prior art radial expansible.

FIG. 2 a, is an isometric view schematic illustrations of a surgicalretractor according to an embodiment of the present invention.

FIG. 2 b, is an exploded, isometric top view schematic illustrations ofa surgical retractor, up to main assemblies, according to an embodimentof the present invention.

FIG. 2 c, is an exploded, isometric top view schematic illustrations ofa surgical retractor, up to elements, according to an embodiment of thepresent invention.

FIG. 3 a is a top view schematic illustration of a surgical retractor,without adaptor, according to an embodiment of the present invention,upon which a section plane a-a is marked.

FIG. 3 b is a cross sectional view a-a illustration of a surgicalretractor, according to an embodiment of the present invention.

FIG. 4 a is a top view schematic illustration of a guarding ring,according to an embodiment of the present invention, upon which asection plane b-b is marked.

FIG. 4 b is a side view schematic illustration of the guarding ring,according to an embodiment of the present invention.

FIG. 4 c is a top view schematic illustration of a lighting sourcesupporter, according to an embodiment of the present invention, uponwhich a section plane c-c is marked.

FIG. 4 d is an isometric bottom view schematic illustration of alighting source supporter, according to an embodiment of the presentinvention.

FIG. 4 e is an exploded side view schematic illustration of a lightingassembly, according to an embodiment of the present invention.

FIG. 4 f is an exploded isometric top view schematic illustration of alighting assembly, according to an embodiment of the present invention.

FIG. 4 g is a side view schematic illustration of a lighting assembly,according to an embodiment of the present invention.

FIG. 4 h is a cross sectional view b-b illustration of a guarding ringand a cross sectional view c-c illustration of a lighting sourcesupporter according to an embodiment of the present invention.

FIG. 5 a is an isometric top view schematic illustration of a coverdisc, according to an embodiment of the present invention.

FIG. 5 b is a side view schematic illustration of a cover disc,according to an embodiment of the present invention.

FIG. 5 c is an isometric bottom view schematic illustration of a coverdisc and lighting source supporter, according to an embodiment of thepresent invention.

FIG. 5 d is an isometric top view schematic illustration of a coverdisc, and of lighting source supporter, according to an embodiment ofthe present invention.

FIG. 6 a is an isometric top view schematic illustration of a grooveddisc, according to an embodiment of the present invention.

FIG. 6 b is side view schematic illustration of a grooved disc,according to an embodiment of the present invention.

FIG. 6 c is bottom view schematic illustration of a grooved disc and acentral rod, according to an embodiment of the present invention.

FIG. 7 a is side view schematic illustration of a central rod, accordingto an embodiment of the present invention.

FIG. 7 b is bottom view schematic illustration of a central rod headdome, according to an embodiment of the present invention.

FIG. 8 a is an isometric top view schematic illustration of a channeleddisc, according to an embodiment of the present invention.

FIG. 8 b is side view schematic illustration of a channeled disc,according to an embodiment of the present invention.

FIG. 8 c is bottom view schematic illustration of a channeled disc,according to an embodiment of the present invention, upon which asection plane d-d is marked.

FIG. 8 d is cross sectional view d-d illustration of a track, accordingto an embodiment of the present invention.

FIG. 9 a is an isometric top view schematic illustration of casing,according to an embodiment of the present invention.

FIG. 9 b is a side view schematic illustration of a casing, according toan embodiment of the present invention.

FIG. 9 c is an exploded side view schematic illustration of casing,according to an embodiment of the present invention.

FIG. 9 d is a side view schematic illustration of a casing bolt,according to an embodiment of the present invention.

FIG. 10 a is an isometric top view schematic illustration of a rib and amain slider combined together, according to an embodiment of the presentinvention.

FIG. 10 b is an exploded isometric top view schematic illustration of amain slider, according to an embodiment of the present invention.

FIG. 10 c is a top view schematic illustration of a slider main body,according to an embodiment of the present invention, upon which asection plane e-e is marked.

FIG. 10 d is a cross sectional view e-e illustration of a slider mainbody, according to an embodiment of the present invention.

FIG. 10 e is a partial side view illustration of a rib, according to anembodiment of the present invention.

FIG. 10 f is a partial side view illustration of a rib and a mainslider, according to an embodiment of the present invention.

FIG. 10 g is a partial side view illustration of a rib and a mainslider, according to an embodiment of the present invention.

FIG. 10 h is a side view illustration of a rib, an angular adjustmentbolt and a main slider, partially sectioned, according to an embodimentof the present invention.

FIG. 10 i is a side view illustration of a main slider, according to anembodiment of the present invention.

FIG. 11 is a side view illustration of a rib, an angular adjustment boltand a main slider, partially sectioned, in six stages of separation,according to an embodiment of the present invention.

FIG. 12 a is a side view illustration of a rib, according to anembodiment of the present invention.

FIG. 12 b is a side view illustration of a rib, according to anembodiment of the present invention.

FIG. 12 c is a side view illustration of two ribs, according to anembodiment of the present invention.

FIG. 13 a is a side view illustration of a rib, according to anembodiment of the present invention, upon which a section plane f-f ismarked.

FIG. 13 b is a cross sectional view f-f illustration of a rib, accordingto an embodiment of the present invention.

FIG. 13 c is six cross sectional views f-f illustration of six ribs,according to an embodiment of the present invention.

FIG. 14 a is a side view illustration of a rib, according to anembodiment of the present invention.

FIG. 14 b is a side view illustration of a rib with a rib hook,according to an embodiment of the present invention.

FIG. 14 c is a side view illustration of a rib, according to anembodiment of the present invention.

FIG. 14 d is an isometric view illustration of six ribs, and a flexiblesleeve, according to an embodiment of the present invention.

FIG. 14 e is a side view illustration of a rib having rib segments, in arelaxed state, according to an embodiment of the present invention.

FIG. 14 f is a side view illustration of rib having rib segments, in aflexed state, according to an embodiment of the present invention.

FIG. 14 g is an isometric view illustration of a rib, having ribsegments, in a relaxed state, according to an embodiment of the presentinvention.

FIG. 14 h is an isometric view illustration of a rib, having ribsegments, in a relaxed state, according to an embodiment of the presentinvention, with the rib segments distanced from each other.

FIG. 15 a is an isometric top view illustration of a transmission,partially exploded, according to an embodiment of the present invention.

FIG. 15 b is an isometric bottom view illustration of a transmission,partially exploded, according to an embodiment of the present invention.

FIG. 16 a is a top view illustration of a carrier, according to anembodiment of the present invention.

FIG. 16 b is a back view illustration of a carrier, according to anembodiment of the present invention.

FIG. 16 c is a side view illustration of a carrier, according to anembodiment of the present invention.

FIG. 16 d is an isometric top view illustration of a carrier, and atransmission, according to an embodiment of the present invention.

FIG. 16 e is an isometric bottom view illustration of a carrier, and achanneled disc, according to an embodiment of the present invention.

FIG. 17 a is an isometric top view illustration of a carrier, and anadaptor, according to an embodiment of the present invention.

FIG. 17 b is an exploded isometric top view illustration of a carrier,and an adaptor, according to an embodiment of the present invention.

FIG. 18 a is an isometric top view illustration of six ribs, in a closedstate, according to an embodiment of the present invention.

FIG. 18 b is an isometric top view illustration of six ribs, in anopened state, according to an embodiment of the present invention.

FIG. 18 c is an isometric top view illustration of six ribs, in a closedstate, according to an embodiment of the present invention.

FIG. 18 d is an isometric top view illustration of six ribs, in anopened state, according to an embodiment of the present invention.

FIG. 18 e is an isometric top view illustration of six ribs, in anopened state, according to an embodiment of the present invention.

FIG. 18 f is a bottom view illustration of six ribs, according to anembodiment of the present invention.

FIG. 19 a is a bottom view illustration of a grooved disc, and six mainsliders, in closed state, according to an embodiment of the presentinvention.

FIG. 19 b is a bottom view illustration of a grooved disc, and six mainsliders in opened state, according to an embodiment of the presentinvention.

FIG. 20 is a side view illustration of a rib having sensors, and a blockdiagram of transducers, according to an embodiment of the presentinvention.

FIG. 21 is a side view illustration of a surgical retractor afterpenetration and opening for the purpose of performing spinal minimalinvasive neurosurgery, according to an embodiment of the presentinvention.

FIG. 22 is a side view illustration of two surgical retractors afterpenetration and opening for the purpose of performing spinal minimalinvasive neurosurgery, according to an embodiment of the presentinvention.

FIG. 23 is a side view illustration of a rib having a rib hook, insideskin and muscle, according to an embodiment of the present invention.

FIG. 24 is a side view illustration of a surgical retractor at threedifferent angles, according to an embodiment of the present invention.

FIG. 25 is a side view illustration of a surgical retractor at twodifferent angles, according to an embodiment of the present invention.

FIG. 26 is an isometric view illustration of a surgical retractorconnected to holding arms, according to an embodiment of the presentinvention.

FIGS. 27 a-27 f are side view illustrations of a surgical retractor atsix different stages of opening within the operated patient's body,

FIG. 28 is a flow chart that schematically illustrates a method ofoperation for decompression of spinal stenosis, in accordance with anembodiment of the present invention.

FIG. 29 a is an isometric top view schematic illustration of a surgicalretractor according to an embodiment of the present invention.

FIG. 29 b is a side view schematic illustration of the surgicalretractor of

FIG. 29 a according to an embodiment of the present invention.

FIG. 30 is an exploded, isometric top view schematic illustration of thesurgical retractor of FIG. 29 a, according to an embodiment of thepresent invention.

FIG. 31 a is a side view schematic illustrations of a segment of achanneled disc, an angular adjustment bolt, a linear adjustment bolt, amain slider, a slider pivot, and a rib of the surgical retractor of FIG.29 a, according to an embodiment of the present invention.

FIG. 31 b is an isometric top view schematic illustration of a channeleddisc, an angular adjustment bolt, a linear adjustment bolt, a mainslider, and a rib of the surgical retractor of FIG. 29 a, according toan embodiment of the present invention.

FIG. 32 a is a top view schematic illustration of the channeled disc ofthe surgical retractor of FIG. 29 a, according to an embodiment of thepresent invention, upon which a section plane g-g is marked.

FIG. 32 b is a cross sectional view g-g illustrations of the channeleddisc of the surgical retractor of FIG. 29 a, according to an embodimentof the present invention.

FIG. 33 is a top view schematic illustration of the surgical retractorof FIG. 29 a, according to an embodiment of the present invention, uponwhich a section plane h-h is marked.

FIG. 34 is a cross sectional view h-h illustrations of the surgicalretractor of FIG. 29 a, according to an embodiment of the presentinvention.

FIG. 35 a is a top view schematic illustration of a main slider of thesurgical retractor of FIG. 29 a, according to an embodiment of thepresent invention, upon which a section plane i-i is marked.

FIG. 35 b is a cross sectional view i-i illustrations of a main sliderof the surgical retractor of FIG. 29 a, according to an embodiment ofthe present invention.

FIG. 36 a is an isometric top view schematic illustration of a surgicalretractor according to an embodiment of the present invention.

FIG. 36 b is a side view schematic illustration of the surgicalretractor of FIG. 36 a, according to an embodiment of the presentinvention.

FIG. 37 is an exploded, isometric top view schematic illustration of thesurgical retractor of FIG. 36 a, according to an embodiment of thepresent invention.

FIG. 38 is a top view schematic illustration of the surgical retractorof FIG. 36 a, according to an embodiment of the present invention, uponwhich a section plane j-j is marked.

FIG. 39 is a cross sectional view j-j illustration of the surgicalretractor of FIG. 36 a, according to an embodiment of the presentinvention.

FIG. 40 is a side view schematic illustration of an angular adjustmentbolt, a main slider, a slider pivot, and a rib of the surgical retractorof FIG. 36 a, according to an embodiment of the present invention.

FIG. 41 is an isometric top view schematic illustration of a mainslider, and an opening mechanism slider of the surgical retractor ofFIG. 36 a, according to an embodiment of the present invention.

FIG. 42 is an isometric top view schematic illustration of a mainslider, and a segment of an external disc of the surgical retractor ofFIG. 36 a, according to an embodiment of the present invention.

FIG. 43 is an exploded, isometric top view schematic illustration of theopening mechanism first type of the surgical retractor of FIG. 36 a,according to an embodiment of the present invention.

FIG. 44 a is an exploded, isometric top view schematic illustration ofthe opening mechanism second type of the surgical retractor of FIG. 36a, according to an embodiment of the present invention.

FIG. 44 b is an isometric top view schematic illustration of the openingmechanism second type of the surgical retractor of FIG. 36 a, accordingto an embodiment of the present invention.

DETAILED DESCRIPTION OF EMBODIMENTS

The present invention is a surgical retractor. The principles andoperation of a surgical retractor according to the present invention maybe better understood with reference to the drawings and the accompanyingdescription.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not limited in its applicationto the details of construction and the arrangement of the components setforth in the following description or illustrated in the drawings.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. The materials, dimensions,methods, and examples provided herein are illustrative only and are notintended to be limiting.

The following list is a legend of the numbering of the applicationillustrations:

2 surgical retractor

10 mechanism for transferring of linear and rotational movements

11 cover disc

11 a cover disc base

11 b cover disc base

11 c cover disc wall

11 d cover disc wall hole

11 e cover disc wall openings

11 f cover disc supports

11 g cover disc base hole

11 i cover disc perforation

11 j cover disc holding pin

12 grooved disc

12 a grooved disc central perforation

12 b curved groove

12 c grooved disc outer surface

12 d grooved disc hole

12 e grooved disc teeth

12 ao grooved disc central perforation center

12 bo groove radius origin

12 f grooved disc body

13 channeled disc

13 a channeled disc base

13 b channeled disc wall

13 c channeled disc wall niche

13 d channeled disc wall hole

13 e channeled disc perforation

13 f channeled disc long slot

13 g channeled disc short slot

13 h track

13 i track side wall

13 j track upper wall

13 k channel

13 l channel upper opening

13 m channeled disc wall tenon

13 n lamp housing

13 p channeled disc wire hole

14 a angular adjustment bolt

14 b linear adjustment bolt

14 c linear adjustment bolt head

15 main slider

15 a slider main body

15 b slider upper body

15 c slider pin hole

15 d slider arm

15 e slider pivot hole

15 f slider among arms surface

15 g slider niche

15 h slider friction reducer

15 i slider pin

15 j slider pivot

15 op movement toward opening

15 cl movement toward closing

15 m first interior thread

15 n second interior thread

15 p main slider upper portion

15 q main slider mid portion

15 r main slider lower portion

15 s main slider back edge

16 carrier

16 a carrier bow

16 b carrier bow bottom hole

16 c carrier bridge

16 d carrier bridge first hole

16 e carrier bridge second hole

16 f carrier arm

16 g carrier back wall

16 h carrier back wall hole

16 i carrier bow side hole

16 j carrier arm hole

17 transmission

17 a transmission knob

17 b transmission shaft

17 c transmission worm

17 e transmission tubular

17 f transmission first cog wheel

17 g transmission second cog wheel

17 h transmission third cog wheel

18 base disc

19 external disc

19 h external disc stair

20 ribs assembly

21 rib

21 a concave segment of a rib front surface

21 b rib back surface

21 c convex segment of a rib back surface

21 d rib shoulder

21 e rib shoulder concave segment

21 f rib front surface

21 f a rib force arm

21 g rib top end

21 h rib bottom end

21 i rib bottom end projection

21 j rib force arm front surface

21 k rib working arm front surface

21 m rib hole

21 n rib hook

21 p rib hook pin

21 q rib segment

21 r cable tensioner

21 s cable

21 t anchoring point

21 m d movement direction (of a rib)

21 r m rotational movement (of a rib)

21 wa rib working arm

21 o concave segment of a rib front surface origin

23 flexible sleeve

30 central rod

30 a central rod tail

30 b central rod tail slot

30 c central rod head dome

30 s central rod tail symmetrical line

40 adaptor

40 a adaptor rod

40 b lock first part

40 c lock second part

40 d lock connector

40 e lock fastener screw

40 f clip

44 connector

47 clamp

48 holding arm

50 lighting assembly

51 lighting source

51 a lighting source supporter base

51 b lamp

51 c power source

51 d electricity conductors

51 e light reflector

52 lighting source supporter

52 a lighting source supporter base

52 b lighting source supporter wall

52 c lighting source supporter wall slots

52 d lighting source supporter wall shoulder

52 e lighting source supporter wall groove

58 guarding ring

60 a opening mechanism first type

60 a opening mechanism second type

61 a opening mechanism pole

61 b opening mechanism cylinder

61 b a opening mechanism cylinder external thread

61D opening mechanism cylinder internal diameter

62 opening mechanism arms ring

62 a opening mechanism arms ring central hole

62 b opening mechanism arms ring arm

63 opening mechanism arm

63 a opening mechanism arm upper pivot

63 b opening mechanism arm lower pivot

64 opening mechanism slider

64 a opening mechanism slider upper channel

64 b opening mechanism slider bottom channel

64 c opening mechanism slider side channel

64 d opening mechanism slider pushing portion

65 opening mechanism base

65 a opening mechanism base hole

65 b opening mechanism base groove

65 c opening mechanism base track

70 opening mechanism nut

66 a opening mechanism nut body

66 b opening mechanism nut internal thread

66 c opening mechanism nut handle

70 casing

70 a casing bolt

80 a pressure sensor

80 b tissue oxygen saturation sensor

80 c transparent window

80 d electrical conductor

80 e pressure transducer

80 f oxygen saturation sensor

90 body tissue

90 a muscle

90 b spinal canal

90 c vertebra

90 d incision line of lamina

90 e bone

90 f skin

90 g discus hernia

90 h spinosus

90 i spinal cord

90 j lamina

91 wedge

92 fascia

F force (general)

F₁ adjustment bolt force

F₂ body tissue force

F₃ slider pivot force

F₄ test force

F₅ axial force

F₆ radial force

d₁ guarding ring interior diameter

d₂ lighting source supporter base ring interior diameter

d₃ lighting source supporter wall shoulder outer diameter

d₄ lighting source base interior diameter

d₅ slider pivot hole diameter

d₆ gap between the slider pivot and the slider among arms surface

d₇ concave segment of a rib front surface diameter

d₈ rib force arm length

d₉ rib working arm length

d₁₀ rib working arm projection to the center

d₁₁ rib force arm width

d₁₂ rib working arm width

d₁₃ rib bottom end deflection

d₁₄ slider arms gap

d₁₅ rib cross section head cut off length

d₁₆ rib thickness

d₁₇ central rod tail diameter

d₁₈ ribs interior diameter

d₁₉(μ) slider pin distance from the grooved disc central perforationcenter

d₂₀ slider pivot distance from the grooved disc central perforationcenter

d₂₁ upper portion length

d₂₂ mid portion length

d₂₃ lower portion length

r₁ groove radius

r₂ channeled disc perforation radius

r₃ slider among arms surface radius

r₄ convex segment of a rib back surface radius

r₅ rib shoulder concave segment radius

α angle between the slider and the channeled disc

β angle between the rib force arm front surface to the rib working armfront surface

γ rib cross section head angle

μ grooved disc rotational angle

δ rib opening angle

100 prior art radial expansible retractor (PARER)

141 PARER rib

142 PARER rib base

143 PARER rib base hole

144 PARER rib carrier

145 PARER rib carrier pin

146 PARER rib carrier hole

147 PARER rib carrier bolt

148 PARER central rod

151 PARER cover disc

151 a PARER cover central perforation

152 PARER grooved disc

152 a PARER grooved disc central perforation

152 b PARER groove

153 PARER channeled disc

153 a PARER channeled disc central perforation

153 b PARER channel

161 PARER rotating wheel

169 PARER adaptor

Referring now to the drawings, FIG. 2 a, is an isometric top viewschematic illustration of a surgical retractor 2 according to anembodiment of the present invention.

The surgical retractor 2 is shown in an assembled state.

FIG. 2 b, is exploded, isometric top view schematic illustrations of asurgical retractor 2, up to main assemblies, according to an embodimentof the present invention.

The active assembly, which practically creates the opening in theoperated patient's body for the purpose of performing the operation, isa ribs assembly 20, which can have an integrated central rod 30, whichleads the penetration into the body. The ribs assembly 20 has a widerange of opening states, which will be described in further detail inthe following. These opening states are commanded and controlled by amechanism for transferring of linear and rotational movements 10. Inaddition, the surgical retractor 2, according to the present invention,can include a lighting assembly 50 for the purpose of illuminating theoperation area, a guarding ring 58 to prevent entry of foreign objects,dust, dirt, etc., into the surgical retractor 2, and adaptor 40 for thepurpose of connection to a holder device.

FIG. 2 c, is exploded, isometric top view schematic illustrations of asurgical retractor 2, up to elements, according to an embodiment of thepresent invention.

The lighting assembly 50, according to an embodiment of the presentinvention, includes lighting source 51 and lighting source supporter 52.The mechanism for transferring of linear and rotational movement 10,according to an embodiment of the present invention, includes cover disc11, grooved disc 12, channeled disc 13, six angular adjustment bolts 14a, six main sliders 15, a carrier 16, and a transmission 17. The ribsassembly 20, according to an embodiment of the present invention,includes six ribs 21.

According to another embodiment of the present invention the quantity ofribs 21 is other than six, and therefore the quantities of the otherelements, quantified as six in the present illustration, arecorrespondingly quantified.

The central rod 30, according to an embodiment of the present invention,includes central rod tail 31, and central rod head dome 32. The adaptor40, according to an embodiment of the present invention, includes one ormore adaptor rods 40 a, lock first part 40 b, and lock fastener screw 40e .

As noted, the quantities of elements noted above are in no way limitingthe present invention, and there may be other combinations ofquantities, such as eight ribs 21. The positions and connections ofthese assemblies, also with regard to each other, their functions, andmethods of operation, will be specified in the following.

While the general preference is for a surgical retractor 2 suitable forrepeated use, made such that it can be sterilized, sterilization of thecomponents can be avoided by integration of certain single-usecomponents. Examples of possible single-use components are ribs 21 andlighting source 51.

FIG. 3 a is a top view schematic illustration of a surgical retractor 2,without an adaptor, according to an embodiment of the present invention,upon which a section plane a-a is marked.

FIG. 3 b is a cross sectional view a-a, isometric top illustration of asurgical retractor 2, according to an embodiment of the presentinvention.

The section shows the positions of elements relative to each other. Rib21 is engaged within a main slider 15. The cover disc 11 encases themain slider 15 and the grooved disc 12 from the outside, and isconnected to the channeled disc 13. An angular adjustment bolts 14 a isengaged with the cover disc 11 and can be in contact with rib 21.

FIG. 4 a is a top view schematic illustration of a guarding ring 58,according to an embodiment of the present invention, upon which asection plane b-b is marked.

As noted, the guarding ring 60 is meant to prevent the entry of foreignobjects, dust, dirt, etc., into the surgical retractor.

The guarding ring 58 is shaped as a flat ring, having a guarding ringinterior diameter d₁. This inner diameter must be of a sufficient sizeto enable passage of the operating tools, as well as to provide thesurgeon with a wide enough visual field. The value of this diametershould preferably be no smaller than 50 millimeters.

FIG. 4 b is a side view schematic illustration of the guarding ring 58,according to an embodiment of the present invention.

FIG. 4 c is a top view schematic illustration of a lighting sourcesupporter 52, according to an embodiment of the present invention, uponwhich a section plane c-c is marked.

FIG. 4 d is an isometric bottom view schematic illustration of alighting source supporter 52, according to an embodiment of the presentinvention.

The lighting source supporter 52 includes a lighting source supporterbase 52 a, which can be shaped as a ring, having a lighting sourcesupporter base ring interior diameter d_(2.)

This diameter must also be of a sufficient size, similarly to thediameters of other elements to be described in the following, for thesame reasons given with regard to the size of guarding ring interiordiameter d₁ (not shown in the present drawings).

Surrounding the lighting source supporter base 52 a is a lighting sourcesupporter wall 52 b with a walled cylinder shape, on which are lightingsource supporter wall slots 52 c, which are meant to prevent disruptionof the movement of other elements.

The lighting source supporter wall 52 b in the configuration shown inthe present illustrations protrudes slightly above and beneath thelighting source supporter base 52 a, and the part that protrudes beneathhas lighting source supporter wall grooves 52 e.

FIG. 4 e is an exploded side view schematic illustration of a lightingassembly 50, according to an embodiment of the present invention.

The lighting assembly 50 shown in the present illustration is composedof the lighting source supporter 52 and lighting source 51; howeverother configurations can also be used, with the lighting assembly 50being composed of a single unit.

The lighting source 51 includes a lighting source base 51 a and one ormore lamps 51 b, which can also be light emitting diode (LED) lights.

According to one embodiment of the present invention, at least one lamp51 b is an ultra violet (UV) LED, which provides disinfection during thesurgical procedure.

The lighting source 51, if not suitable for repeated sterilization, is adisposable component, meant for single-time use. All other elements mustbe composed of materials suitable for medical standard repeatedsterilization.

FIG. 4 f is an exploded isometric top view schematic illustration of alighting assembly 50, according to an embodiment of the presentinvention.

The lighting source 51 has a lighting source base interior diameter d₄.The external shape of the lighting source 51 at least partially conformsto the internal shape of the lighting source supporter 52, so that theyare fastened to each other by force of friction, which is no smallerthan the weight of each of these elements.

FIG. 4 g is a side view schematic illustration of a lighting assembly50, according to an embodiment of the present invention.

The present illustration shows the lighting source supporter wall 52 band the lighting source supporter base 51 a, engaged with each other. Inanother possible configuration, the lighting assembly 50 is composed ofone unit whose shape is practically identical to that of the engagedunits, other than lamps 51 b. The lamps 51 b are electrically fed frompower source 51 c by means of electricity conductors 51 d.

Attached to each lamp 51 b, according to an embodiment of the presentinvention, is a light reflector 51 e, shown magnified in circle C, whichreflects the light so as to facilitate the surgeon's good view of theworking area, without glaring directly into the surgeon's eyes.

FIG. 4 h is a cross sectional view b-b illustration of a guarding ring58 and a cross sectional view c-c illustration of a lighting sourcesupporter 52 according to an embodiment of the present invention.

The top part of the lighting source supporter 52 has a lighting sourcesupporter wall shoulder 52 d, shown magnified in circle A, which has alighting source supporter wall shoulder outer diameter d₃.

The lighting source supporter wall shoulder outer diameter d₃ and theguarding ring interior diameter d₁ are practically of the same value, sothat when the guarding ring 58 is engaged with lighting source supporter52, a friction force occurs between them, preventing the guarding ring58 from separating as a result of gravity or of movement. There areother possible methods of connecting the guarding ring 58 with thelighting source supporter 52, such as by means of screwing, riveting,etc., and even by means of a fixed connection, when they are composed asa single unit.

FIG. 5 a is an isometric top view schematic illustration of a cover disc11, according to an embodiment of the present invention.

The cover disc 11 includes a cover disc base 11 a having several coverdisc base interior threads 11 b and cover disc base holes 11 g.

The presence of the cover disc base holes 11 g serves the purpose ofreducing weight and enables effective penetration of materials such asdetergents during rinsing and disinfection.

The cover disc base 11 a is shaped as a flat ring, the internal part ofthe ring being disposed with cover disc supports 11 f, and its externalcircumference is mounted within a cover disc wall 11 c.

The cover disc wall 11 c is shaped as a walled cylinder, having coverdisc wall holes 11 d, and cover disc wall openings 11 e.

The cover disc supports 11 f protrude into a cover disc perforation 11i.

FIG. 5 b is a side view schematic illustration of a cover disc 11,according to an embodiment of the present invention.

FIG. 5 c is an isometric bottom view schematic illustration of a coverdisc 11 and lighting source supporter 52, according to an embodiment ofthe present invention.

In the configuration shown in the present illustration, the entire coverdisc support 11 f is within lighting source supporter wall 52 b,conforming to a lighting source supporter wall groove 52 e.

FIG. 5 d is an isometric top view schematic illustration of a cover disc11, and of lighting source supporter 52, according to an embodiment ofthe present invention.

Both elements are engaged in each other, with their shapes anddimensions conforming for the purpose of this engagement.

FIG. 6 a is an isometric top view schematic illustration of a grooveddisc 12, according to an embodiment of the present invention.

The grooved disc 12 is shaped like a flat ring, with a grooved disccentral perforation 12 a in its center, and a grooved disc outer surface12 c, some of which comprises grooved disc teeth 12 e. The grooved discteeth 12 e serve the purpose of providing the grooved disc 12 withrotational movement.

FIG. 6 b is side view schematic illustration of a grooved disc 12,according to an embodiment of the present invention.

FIG. 6 c is bottom view schematic illustration of a grooved disc 12 anda central rod 30, according to an embodiment of the present invention.

This view shows curved grooves 12 b whose depth, in the present case, issmaller than the thickness of the grooved disc 12, however can, in otherconfigurations according to the present invention, be for the entiredepth of the grooved disc 12. If the depth of the curved grooves 12 b issmaller than the thickness of the grooved disc 12, grooved disc holes 12d can be added to facilitate a better flow of disinfectant materialthrough them into the curved grooves 12 b.

The grooved disc 12 serves for opening and closing the aperture createdby the ribs 21 (not shown in the present illustration). Each curvedgroove 12 b corresponds with one rib 21, and if all of the curvedgrooves 12 b have the same curve shape, the distance of each rib 21 fromthe grooved disc central perforation center 12 ao is consistently thesame, in every state of rotation of the grooved disc 12, namely all ofthe ribs 21, at every cross section, are on a common circle.

According to another embodiment of the present invention, not all of thecurved grooves 12 b have the same curve shape. The curved grooves 12 bcan have many curve shapes. In the case shown in the presentillustration, the curve shape of each one of them is a segment of acircle. When viewing the grooved disc 12, the groove radius origin 12 bois not at the same point as the grooved disc central perforation center12 ao.

The grooved disc central perforation center 12 ao is practicallypositioned on the central rod tail symmetrical line 30 s.

The grooved disc 12 has a grooved disc body 12 f, whose general shape isthat of a flat ring, on part of whose circumference are grooved discteeth 12 e.

FIG. 7 a is side view schematic illustration of a central rod 30,according to an embodiment of the present invention.

The central rod 30 has a central rod tail 30 a, having a central rodtail diameter d₁₇ and in the configuration shown in the presentillustration, it is slotted with central rod tail slots 30 b, and has,at its end, central rod head dome 30 c whose tip is tapered toward itsend, from a side view.

The slots 30 b serve the surgeon for the purpose of measuringpenetration depth. For example, slots 30 b can be marked at regularintervals of one centimeter each, and the measure of penetration canthen be determined according to the numbers marked outside of thepatient's body.

The central rod tail 30 a has a central rod tail symmetrical line 30 s.This line is disposed in a fixed location relative to the variouscomponents of the surgical retractor, according to the presentinvention, which do not move relative to each other when the central rod30 is disposed between the ribs 21 (not shown in the presentlustration), when they are in a closed mode, as they are at thebeginning of insertion into the patient's body. This line can serve as areference line for measurement of angles and distances, even when thecentral rod 30 is not in the position presently described.

The central rod 30 is designated as the leader guiding the penetrationinto the body of the operated patient. At the beginning of theprocedure, it is centered between the ribs 21, (not shown in the presentillustration), which are closed, while the central rod head dome 30 cprotrudes from them, and is first to come into contact with the operatedpatient's body.

The central rod 30 is taken out and removed from the operated area,after achieving sufficient opening of the ribs 21.

FIG. 7 b is bottom view schematic illustration of a central rod headdome 30 c, according to an embodiment of the present invention.

In the configuration shown in the present invention, from a bottom view,the central rod head dome 30 c has an oval shape; however it can haveother shapes as well.

FIG. 8 a is an isometric top view schematic illustration of a channeleddisc 13, according to an embodiment of the present invention.

The channeled disc 13 includes a channeled disc base 13 a, which has atits circumference the channeled disc wall 13 b, which has severalchanneled disc wall niche 13 c, as well as two channeled disc walltenons 13 m.

This shape of the circumference of the channeled disc 13 serves thepurpose of conforming to other component at the time of assembly;however other shapes can also be used according to the presentinvention. Furthermore, for the purpose of connecting components, thereare several channeled disc wall holes 13 d, having internal screwthreading.

FIG. 8 b is side view schematic illustration of a channeled disc 13,according to an embodiment of the present invention.

FIG. 8 c is bottom view schematic illustration of a channeled disc 13,according to an embodiment of the present invention, upon which asection plane d-d is marked.

In the center of the channeled disc 13 is channeled disc perforation 13e, which is shaped as a circle having channeled disc perforation radiusr₂. The channeled disc perforation radius r₂ disc is likely to be theelement most limiting the maximal visual field of view that can beachieved during an operation, and the element most limiting thedimensions of the operating tools, therefore its size should preferablybe no smaller than 15 millimeters.

The channeled disc 13 is slotted for its entire depth with channeleddisc long slots 13 f in order to enable positioning and movement of theribs 21 (not shown in the present illustration), and in the channeleddisc short slots 13 g, which create cavities for the positioning of thelamps 51 b.

FIG. 8 d is cross sectional view d-d illustration of a track 13 h,according to an embodiment of the present invention.

The channeled disc 13 also engages a component that can make radiallinear movement relative to a single point, the main slider 15 (which,along with other elements mentioned in the description of the presentillustration, is not shown in the present illustration). For thispurpose, the channeled disc 13 has tracks 13 h. Every track 13 h isclosed on its bottom, in view of the orientation of the presentillustration, by the channeled disc base 13 a, on both of its sides bytwo track side walls 13 i, and on its top by track upper wall 13 j.

The track upper wall 13 j has a channel upper opening 13 l, which hassuitable dimension for longitudinal movement of the slider upper body 15b. The space created between the elements described, as shown in thepresent illustration, comprises the channel 13 k, whose dimensions aresuitable for those of a main slider 15 so as to enable its radiallongitudinal movement, and to prevent its movement in any otherundesired direction.

FIG. 9 a is an isometric top view schematic illustration of casing 70,according to an embodiment of the present invention.

FIG. 9 b is a side view schematic illustration of casing 70, accordingto an embodiment of the present invention.

FIG. 9 c is an exploded side view schematic illustration of casing 70,according to an embodiment of the present invention.

According to the embodiment shown in the present illustration, theengagement of the cover disc 11 with the channeled disc 13 is done bymeans of geometrically conforming both to each other, together forming acasing 70 suitable for carrying grooved disc 12 (not shown in thepresent illustration), and granting it smooth rotational movement, aswell as for carrying and granting smooth movement of other components.The present illustration shows that the cover disc wall 11 c and thecover disc wall hole 11 d respectively conform with the channeled discwall niche 13 c and the channeled disc wall hole 13 d, thus enabling asuccessful connection of the cover disc 11 with the channeled disc 13.

FIG. 9 d is a side view schematic illustration of a casing bolt 70 a,according to an embodiment of the present invention.

Casing bolt 70 a, one of which is shown in the present illustrationmagnified relative to the previous illustration, completes theconnection of the cover disc 11 together with the channeled disc 13.

FIG. 10 a is an isometric top view schematic illustration of a rib 21and a main slider 15 combined together, according to an embodiment ofthe present invention.

All the ribs 21 and main sliders 15 are arranged in engaged pairs. Everymain slider 15 is designated to linearly move one of the ribs 21.

Rib 21 has a rib back surface 21 b and a rib front surface 21 f. The ribfront surfaces 21 f of all the ribs 21 all face inwards relative to thespatial shape that they form together.

The rib back surface 21 b and a rib front surface 21 f are eachdivisible into several segments according to the structural parts of thetype of rib 21 to which they belong.

FIG. 10 b is an exploded isometric top view schematic illustration of amain slider 15, according to an embodiment of the present invention.

The main slider 15 includes a slider main body 15 a, whose shape anddimensions are suitable for maintaining back and forth linear movementwithin a channel 13 k, (not shown in the present illustration).

From the top part of the slider main body 15 a, protrudes slider upperbody 15 b, whose shape and dimensions are suitable for maintaining backand forth linear movement within a channel upper opening 131, (not shownin the present illustration). Above slider upper body 15 b, protrudes aslider pin 15 i, whose shape and dimensions are suitable for maintainingback and forth linear movement within curved groove 12 b, (not shown inthe present illustration).

The slider pin 15 i can be an integral part of the slider upper body 15b and of the slider main body 15 a, or can be partially engaged withinslider pin hole 15 c.

The part of main slider 15 designated to be engaged with rib 21, (notshown in the present illustration), has two slider arms 15 d, the spacebetween which is suitable to contain a rib 21, so as to enable itrotational movement while preventing its lateral movement. Between botharms 15 d is a slider pivot 15 j, within two slider pivot holes 15 e.

Between both slider arms 15 d, is a perpendicularly disposed slideramong arms surface 15 f. At the bottom of the slider main body 15 a,near the end farther from the slider arms 15 d, is an optional sliderniche 15 g, within which is a slider friction reducer 15 h thatprotrudes very slightly relative to the dimensions of the main slider15, from beneath the main slider 15. The slider friction reducer 15 h iscomposed of a material, such as silicone, having a smaller frictioncoefficient than the friction coefficient of the material, for examplesteel, composing the main slider 15.

FIG. 10 c is a top view schematic illustration of a slider main body 15a, according to an embodiment of the present invention, upon which asection plane e-e is marked.

The present illustration shows a view from the top of the slider amongarms surface 15 f. Between both of the slider arms 15 d, is a sliderarms gap d₁₄.

FIG. 10 d is a cross sectional view e-e illustration of a slider mainbody 15 a, according to an embodiment of the present invention.

The present illustration indicates three dimensions of specialsignificance for the purpose of conforming with a rib 21 (not shown inthe present illustration), which are a slider pivot hole diameter d₅, agap between the slider pivot and the slider among arms surface d₆ and aslider among arms surface radius r₃.

FIG. 10 e is a partial side view illustration of a rib 21, according toan embodiment of the present invention.

The present illustration shows details and dimensions of specialsignificance for the purpose of conforming with main slider 15, (notshown in the present illustration). A concave segment of a rib frontsurface 21 a serves to transmit force during opening movement of rib 21from the slider pivot 15 j, (not shown in the present illustration). Thepreferred shape of concave segment of a rib front surface 21 a is a halfcircle whose center is defined as a concave segment of a rib frontsurface origin 21 o, having a concave segment of a rib front surfacediameter d₇

The convex segment of a rib back surface 21 c has a section shape of acircle, whose center is concave segment of a rib front surface origin 21o, and which has a convex segment of a rib back surface radius r₄.

The maximum value of the convex segment of a rib back surface radius r₄is at most equal to the value of the gap between the slider pivot andthe slider among arms surface d₆ (not shown in the presentillustration), so as to enable replacement of rib 21.

A rib shoulder 21 d serves to transmit force from the slider main body15 a, (not shown in the present illustration) in order to performclosing. Part of rib shoulder 21 d has a rib shoulder concave segment 21e, having a rib shoulder concave segment radius r₅.

The value of the rib shoulder concave segment radius r₅ corresponds withthe slider among arms surface radius r₃ (not shown in the presentillustration).

FIG. 10 f is a partial side view illustration of a rib 21 and a mainslider 15, according to an embodiment of the present invention.

The present illustration shows a state of movement toward opening 15 o,in which the slider pivot 15 j is moving to the right, in theorientation shown in the present illustration, and applies force to rib21 in the area of contact with the concave segment of a rib frontsurface 21 a.

FIG. 10 g is a partial side view illustration of a rib 21 and a mainslider 15, according to an embodiment of the present invention.

The present illustration shows a state of movement toward closing 15 cl,in which main slider 15 moves to the left, in the orientation shown inthe present illustration, and applies force, to rib 21 in the area ofcontact with the slider among arms surface 15 f, which acts on the ribshoulder 21 d. The rib shoulder 21 d, also limits the rotationalmovement of rib 21 clockwise, according to the view shown in the presentillustration, prevention of the rotational movement occurs duringcontact between the rib shoulder 21 d with the slider among arms surface15 f.

FIG. 10 h is a side view illustration of a rib 21, an angular adjustmentbolt 14 a and a main slider 15, partially sectioned, according to anembodiment of the present invention.

The present illustration describes forces affecting rib 21 when it isinside the operated patient's body when body tissue 90 applies pressureto it, the resultant force of which, the body tissue force F₂, isapplied to a specific point on a rib working arm 21 wa of the rib 21.Conversely, in the state shown in the present illustration, the angularadjustment bolts 14 a applies adjustment bolt force F₁ on a rib forcearm 21 fa. Both the adjustment bolt force F₁ and the body tissue forceF₂ are balanced by a slider pivot force F₃, which is applied in theopposite direction.

The concave segment of a rib front surface origin 210 comprises apossible rotational center for rib 21, and its location determines whichpart of the rib 21 acts as the rib working arm 21 wa and which acts asthe rib force arm 21 fa.

Furthermore, when the angular adjustment bolts 14 a applies adjustmentbolt force F₁ to the rib force arm 21 fa, rib 21 rotatescounterclockwise, in the view shown in the present illustration, and agap is formed between the rib shoulder concave segment 21 e and theslider among arms surface 15 f.

The rib force arm 21 fa has a rib force arm length d₈ and the ribworking arm 21 wa has a rib working arm length d₉.

FIG. 10 i is a side view illustration of a main slider 15, according toan embodiment of the present invention.

When the main slider 15 moves toward opening, to the right in theorientation of the present illustration, angle α is formed between theslider and the channeled disc and the contact between main slider 15with the surface upon which it moves is only in the area of the sliderfriction reducer 15 h.

FIG. 11 is a side view illustration of a rib 21, an angular adjustmentbolt 14 a and a main slider 15, partially sectioned, in six stages ofseparation, according to an embodiment of the present invention.

These stages are part of a method for replacing rib 21, and theydemonstrate the manner of removing rib 21 from its place, from a statesuitable for operation, engaged with main slider 15. Similarly, but withreversal of the order of stages, rib 21 is engaged with a main slider15.

The stages are:

Starting (stage A), showing one possible starting state, in which theangular adjustment bolt 14 a is in contact with rib 21;

retreating of the angular adjustment bolt 14 a (stage B);

rotating clockwise of the rib 21 (stage C);

pulling up the rib 21 as much as possible (stage D)

rotating counter-clockwise of the rib 21 (stage E); and

separating the rib 21 from the main slider 15 by pulling up the rib 21all the way out (stage F).

In order to enable this removal there cannot be any width dimension ofrib 21, required to go through the gap between the slider pivot and theslider among arms surface d₆, which is wider than this gap.

FIG. 12 a is a side view illustration of a rib 21, according to anembodiment of the present invention.

The present illustration shows the division of the rib 21 into two arms.In a state in which the concave segment of a rib front surface 21 apractically serves as a support point and both ends, the rib bottom end21 h and the rib top end 21 g, are subject to forces F, which arehorizontal according to the orientation of the present illustration; thepart of rib 21 in which there is a counterclockwise twisting effort isdefined as rib force arm 21 fa and the part in which there is aclockwise twisting effort is defined as rib working arm 21 wa.

Close to the rib bottom end 21 h, there is a rib bottom end projection21 i, which is designated to facilitate prevention of rib 21 beingpushed outward and upward as a result of forces applied to it by theoperated patient's body tissue.

FIG. 12 b is a side view illustration of a rib 21, according to anembodiment of the present invention.

The present illustration defines additional features of rib 21. Rib 21,according to an embodiment of the present invention, is practicallyrigid, considering the forces that may be applied to it duringperformance of an operation on a human body. The term “rigid” is toindicate that the rib practically does not bend, or deflect, when areasonable force, moment, or torque from the tissue is applied. Properdesign and production of rib 21 with use of suitable materials such assteel or titanium, can ensure meeting the required test criterion for arib 21 having a rib working arm length d₉ and a maximum rib bottom enddeflection d₁₃, under the activation of test force F₄ at a predefinedlevel on the rib bottom end 21 h, with the rib force arm 21 faharnessed.

A practical example of such a test is the following data:

rib working arm length d₉: 60 centimeter;

test force F₄: 200 Newton; and

maximum rib bottom end deflection d₁₃: 0.4 millimeter.

One effective way of obtaining the required rigidity, without addingunnecessary weight, is by selecting a shape in which rib working arm 21wa has a rib working arm width d₁₂ having a size that tapers toward therib bottom end 21 h.

Similarly to rib force arm 21 fa, there is a rib force arm width d₁₁,which tapers toward rib top end 21 g.

Another feature is the rib working arm projection to the center d₁₀,which is designated to remove the rib force arm 21 fa from the doctor'svisual field. The value of the rib working arm projection to the centerd₁₀ should preferably be at least 10 millimeters, when this distance ismeasured from the concave segment of a rib front surface origin 21 o,perpendicular to the plane on which rib working arm front surface 21 kis disposed.

FIG. 12 c is a side view illustration of two ribs 21, according to anembodiment of the present invention.

The two ribs 21 in the present case are on the same plane and are shownas minor images of each other.

Rib 21 has a rib force arm front surface 21 j and a rib working armfront surface 21 k, which are for most of their lengths in side view,straight. The present illustration shows each one of both ribs 21 at arib opening angle δ at which the rib force arm front surface 21 j isparallel to a symmetry line between both ribs 21. In this state, theangle between the rib force arm front surface and the rib working armfront surface β is equal to rib opening angle δ.

The rib opening angle δ is measured between the symmetrical line 30 sand the rib working arm front surface 21 k.

FIG. 13 a is a side view illustration of a rib 21, according to anembodiment of the present invention, upon which a section plane f-f ismarked.

FIG. 13 b is a cross sectional view f-f, view illustration of a rib 21,according to an embodiment of the present invention.

Rib 21 has a rib thickness d₁₆, which conforms to the dimensions of theslider arms gap d₁₄, so as to enable rotational movement between thetwo, but to enable practically no sideways movement of rib 21. The sideof the section facing forwards is tapered, and has a rib cross sectionhead angle γ, a preferred value of which is 360 degrees divided by thenumber of ribs 21 included in the retractor. The tapered part end is cutoff, and has a rib cross section head cut off length d₁₅.

FIG. 13 c is six cross sectional views f-f illustration of six ribs 21,according to an embodiment of the present invention.

According to an embodiment of the present invention the retractorincludes six ribs 21, however other numbers can be used.

The ribs 21 are shown in the present illustration in a state referred toin the present invention as a closed state, and each one touches theadjacent ones for most of its length rib working arm 21 wa (not shown inthe present illustration). In this closed state, the ribs 21 bind aninternal circle (dashed line in the illustration), having a ribsinterior diameter d₁₈, which conforms to the dimensions of the centralrod tail diameter d₁₇.

FIG. 14 a is a side view illustration of a rib 21, according to anembodiment of the present invention.

According to an embodiment of the present invention, the rib 21 includesa rib hole 21 m. The rib hole 21 m is assembled such that a slider pivot15 j (not shown in the present illustration) is engaged within it, andtheir dimensions conform so as to enable effective rotational movementbetween both.

According to this embodiment, replacement of a rib 21 requires removingand then reinserting the slider pivot 15 j (not shown in the presentillustration) in place.

FIG. 14 b is a side view illustration of a rib 21 with a rib hook 21 n,according to an embodiment of the present invention.

In order to prevent penetration of the patient's skin into the woundcavity, the rib 21, according to an embodiment of the present invention,is equipped with a rib hook 21 n. In order to prevent the addition ofthe rib hook 21 n from hampering the replacement of rib 21, the rib hook21 n must either be sufficiently small, detachable from the rib 21, orfoldable, for example around rib hook pin 21 p, in this case, therotation ability is upward, in the orientation shown in the presentillustration, while downward rotation is not possible beyond the stateshown in the illustration.

FIG. 14 c is a side view illustration of a rib 21, according to anembodiment of the present invention.

According to an embodiment of the present invention, the rib 21 issomewhat flexible, and does not need to meet the definition and testrequirement for rigidity given with regard to the description of FIG. 12b. As such, the rib working arm length d₉ can have a relatively highvalue, and there is no requirement for any large change in values of ribworking arm width d₁₂ according to their positions along the rib workingarm 21 wa, to the extent that their values can be fixed.

FIG. 14 d is an isometric view illustration of six ribs 21, and aflexible sleeve 23, according to an embodiment of the present invention.

The flexible sleeve 23 externally encases the six ribs 21 along theirrib working arms 21 wa, for their entire length or part of it, and isdesignated to prevent tissue from entering the opening created for thepurpose of performing the medical procedure.

The material composing the flexible sleeve 23 can be polyisoprene, anatural polymer, for example, however this material is in no waylimiting the present invention.

Polyisoprene is strong and elastic, is transparent after expansion, isinert, and does not cause allergic reactions.

FIG. 14 e is a side view illustration of rib 21, having rib segments 21q, in a relaxed state, according to an embodiment of the presentinvention.

The rib working arm 21 wa of the rib 21 is divided into several ribsegments 21 q, three in the case of the present illustration.

A cable 21 s is connected at one end to an anchoring point 21 t,disposed within the lower rib segment 21 q.

The cable 21 s is shown in the present illustration as if runningthrough a series of perforations for the length of all parts of atransparent rib 21 and connects at the other end to a cable tensioner 21r. When the cable tensioner 21 r is in a proper state, the cable 21 s isrelaxed and enables minimal distancing of the rib segments 21 q fromeach other, thus enabling creation of a rotational angle in anydirection, if there is no specific device to limit it, between everypair of adjacent rib segments 21 q. Even though the present illustrationshows only one cable 21 s and only one cable tensioner 21 r, this is inno way limiting the present invention, and different quantities of theseelements are also possible.

FIG. 14 f is a side view illustration of rib 21, having rib segments 21q, in a flexed state, according to an embodiment of the presentinvention.

The cable tensioner 21 r applies tensioning force on the cable 21 s,thus causing the rib segments 21 q to join so as to create the desiredexternal shape of rib 21.

The cable 21 s must be composed of a sufficiently strong material suchas carbon nanotubes.

FIG. 14 g is an isometric view illustration of a rib 21, having ribsegments 21 q, in a flexed state, according to an embodiment of thepresent invention.

FIG. 14 h is an isometric view illustration of rib 21, having ribsegments 21 q, in a relaxed state, according to an embodiment of thepresent invention, with the rib segments 21 q distanced from each other.

The distances between the rib segments 21 q shown in the presentillustration are exaggerated, for the purpose of demonstrating the upperpart of each rib segment 21 q, which is one of many possible shapesenabling partial engagement of each rib segment 21 q in the lower partof the rib segments 21 q above it. The present invention is not limitedto any specific number of rib segments 21 q, or any specific position ofthem.

FIG. 15 a is an isometric top view illustration of a transmission 17,partially exploded, according to an embodiment of the present invention.

The transmission 17 is designated to grant rotational movement togrooved disc 12. The movement starts with manual rotation of at leastone of the two transmission knobs 17 a, which transmit rotationalmovement through a transmission tubular 17 e to a transmission shaft 17b, and through that to a transmission worm 17 c. The transmission worm17 c rotates a transmission first cog wheel 17 f, which is rigidlyconnected on a shaft with a transmission second cog wheel 17 g. Thetransmission second cog wheel 17 g rotates a transmission third cogwheel 17 h, which, at the end of the process, grants the necessaryrotational movement to grooved disc 12 by means of the grooved discteeth 12 e. The engagement of the transmission first cog wheel 17 f byrigid connection on a shaft with the transmission second cog wheel 17 gis for the purpose of obtaining the desired transmission ratio, and toprovide a convenient distance for users' hands when forming the openingoperation.

Use of the transmission third cog wheel 17 h, other than its effect onthe transmission ratio, is to distance the transmission knobs 17 a fromthe grooved disc 12.

FIG. 15 b is an isometric bottom view illustration of a transmission 17,partially exploded, according to an embodiment of the present invention.

This transmission can enable controlled opening at a slow rate of 50micrometers per second by applying force of the fingers.

According to the present invention, transmission systems of variousdifferent structures can be used. Likewise, a suitable mechanical enginecan be used instead of manual force.

FIG. 16 a is a top view illustration of a carrier 16, according to anembodiment of the present invention.

The carrier 16 includes a carrier bow 16 a, a carrier bridge 16 c, twocarrier arms 16 f, and a carrier back wall 16 g.

The carrier 16 connects the channeled disc 13 with the adaptor 40 (bothnot shown in the present illustration), and carries the transmission 17,(not shown in the present illustration).

Carrier bow 16 a has carrier bow bottom holes 16 b and carrier bow sideholes 16 i (not shown in the present illustration), for the purpose ofconnection to the channeled disc 13 (not shown in the presentillustration).

In the carrier bridge 16 c there are two holes, a carrier bridge firsthole 16 d, designated to carry the shaft of the transmission third cogwheel 17 h, (not shown in the present illustration) and a carrier bridgesecond hole 16 e, designated to carry the common shaft of thetransmission first cog wheel 17 f and the transmission second cog wheel17 g (both not shown in the present illustration).

FIG. 16 b is a back view illustration of a carrier 16, according to anembodiment of the present invention.

Carrier back wall holes 16 h in the carrier back wall 16 g aredesignated for connection to the adaptor rods 40 a (not shown in thepresent illustration).

FIG. 16 c is a side view illustration of a carrier 16, according to anembodiment of the present invention.

The transmission shaft 17 b (not shown in the present illustration), inan assembled state, runs through carrier arm hole 16 j in the twocarrier arms 16 f.

FIG. 16 d is an isometric top view illustration of a carrier 16, and atransmission 17, according to an embodiment of the present invention.

One transmission knob 17 a is not shown in the present illustration. Thetransmission worm 17 c is mounted upon the transmission shaft 17 b,between both carrier arms 16 f.

The transmission first cog wheel 17 f, the transmission second cog wheel17 g and the transmission third cog wheel 17 h are mounted above thecarrier bridge 16 c, according to the orientation of the presentillustration.

FIG. 16 e is an isometric bottom view illustration of a carrier 16, anda channeled disc 13, according to an embodiment of the presentinvention.

Their joint connection can be by means of screws through the carrier bowbottom holes 16 b and the carrier bow side holes 16 i. The screws can besuch as the casing bolts 70 a, (not shown in the present illustration),with suitable holes, having internal screw threading in the channeleddisc base 13 a and the channeled disc wall 13 b.

FIG. 17 a is an isometric top view illustration of a carrier 16, and anadaptor 40, according to an embodiment of the present invention.

FIG. 17 b is an exploded isometric top view illustration of a carrier16, and an adaptor 40, according to an embodiment of the presentinvention.

FIG. 18 a is an isometric top view illustration of six ribs 21 in aclosed state, according to an embodiment of the present invention.

The number of ribs 21 shown in the present illustration is six, howeverthis is not limiting the present illustration specifically to thisnumber. In this state, the ribs 21 are inserted into the operatedpatient's body, while they are as tightly close to each other aspossible, thus creating an entry puncture of the smallest diameter thatcan be achieved with them. This diameter, which is determined by thewidest section created by the six ribs 21, should preferably be nolarger than 8 mm, while in any case the diameter should be as small asit enabled by the mechanical strength of the ribs 21.

The arrows at the upper part of the present illustration indicatemovement directions 21 md of each one of the ribs 21, if linear openingis required.

FIG. 18 b is an isometric top view illustration of six ribs 21 in anopen state, according to an embodiment of the present invention.

The opening performed in order to achieve this state was with uniformlinear movement of each one of the six ribs 21, such that all six are,at every possible lateral section, on a circle together.

FIG. 18 c is an isometric top view illustration of six ribs 21 in aclosed state, according to an embodiment of the present invention.

The arrows at the lower part of the illustration indicate thepossibility of rotational movement 21 rm of ribs 21, two in this case.

FIG. 18 d is an isometric top view illustration of six ribs 21 in anopen state, according to an embodiment of the present invention.

This state was achieved after performance of rotational movement inopposite directions and equal distance of two ribs 21.

FIG. 18 e is an isometric top view illustration of six ribs 21 in anopen state, according to an embodiment of the present invention.

This state was achieved after performance of uniform linear opening ofall six ribs 21, followed by rotational movement in opposite directionsand equal distance of two ribs 21, both on the same plane of movement.

FIG. 18 f is a bottom view illustration of six ribs 21 in an open state,according to an embodiment of the present invention.

This state was achieved after performance of uniform linear opening ofall six ribs 21, followed by rotational movement in opposite directionsand equal distance of two ribs 21, both on the same plane of movement.

The six ribs 21, at each lateral section, are all on an ellipse.

FIG. 19 a is a bottom view illustration of a grooved disc 12, and sixmain sliders 15, in closed state, according to an embodiment of thepresent invention.

In the closed state of the present illustration, all six of the sliderpivots 15 j are each on a curved groove 12 b designated for it, in alocation in which the slider pins' distance from the grooved disccentral perforation center d₁₉(μ) is minimal.

FIG. 19 b is a bottom view illustration of a grooved disc 12, and sixmain sliders 15, in opened state, according to an embodiment of thepresent invention.

After the grooved disc 12 performs rotational movement of a grooved discrotational angle μ, the slider pins' distance from the grooved disccentral perforation center d₁₉(μ) is maximum. Between both of these endstates, the slider pins' distance from the grooved disc centralperforation center d₁₉(μ) depends on the grooved disc rotational angleμ.

FIG. 20 is a side view illustration of a rib 21 having sensors, and ablock diagram of transducers, according to an embodiment of the presentinvention.

For the purpose of pressure and saturation measurement monitoring duringthe operation, at least one rib 21 is mounted with a pressure sensor 80a and a tissue oxygen saturation sensor 80 b, disposed near the rib backsurface 21 b, and each connected to an electrical conductor 80 d. Thepressure sensor 80 a transmits signals to an pressure transducer 80 e,and the tissue oxygen saturation sensor 80 b transmits signals to anoxygen saturation sensor 80 f.

The pressure sensor 80 a serves the purpose of measuring pressureaccording to the type of tissue applying the pressure, such asintra-cranial pressure, intra-tissue pressure, or retracted tissuepressure

The tissue oxygen saturation sensor 80 b can also be composed of aninfrared diode emitter that emits infrared radiation and a receiver forreceiving the infrared radiation returned from the tissue.

The infrared diode emitter and the receiver are disposed behind atransparent window 80 c, which can also be made of ceramic material orglass.

According to anther embodiment of the present invention the pressuresensor 80 a and the tissue oxygen saturation sensor 80 b are mountedseparately, each on a different rib 21.

FIG. 21 is a side view illustration of a surgical retractor 2, afterinsertion and opening for the purpose of performing spinal minimalinvasive neurosurgery, according to an embodiment of the presentinvention.

The ribs 21 were inserted through the muscle 90 a and opened, in thecase shown in the present illustration, with the opening movements ofall of the ribs 21 being strictly linear.

The insertion was toward the vertebrae 90 c, more specifically towardthe spinal canal 90 b. Subsequently, an incision line of lamina 90 d wasmade. Due to the external shape of the bone 90 e, use was made of ribs21 of varying lengths, with the rib 21 shown as the central one beinglonger.

A wedge 91, shown here magnified relative to the dimensions of thesurgical retractor 2, can serve for opening-distraction and fusion oflamina vertebralis.

FIG. 22 is a side view illustration of two surgical retractors 2 afterinsertion and opening, for the purpose of performing spinal minimalinvasive neurosurgery, according to an embodiment of the presentinvention.

During performance of the operation, use was made of two surgicalretractors 2 and two incision lines of lamina 90 d are made.

When necessary, one retractor can be used to perform an operation on oneside and, after completion on one side, to perform the same operation onthe other side. However, it is optimally preferable to perform asimultaneous bilateral laminotomy (SBL) with minimal time delay, toprevent future anatomical asymmetry in lamina and any unnecessarymovement of the excised lamina, which can cause iatrogenic damage toneural roots and ligaments Likewise, simultaneous insertion of bilateralwedges for symmetric spinal channel decompression (SSCD) is alsopreferable.

The present illustration clearly shows the different lengths of ribs 21relative to each other.

FIG. 23 is a side view illustration of a rib 21, having The presentillustration demonstrates the manner in which the rib hook 21 n supportsskin 90 f and is above fascia 92, while the muscles 90 a are in contactwith rib 21.

FIG. 24 is a side view illustration of a surgical retractor 2 at threedifferent angles, according to an embodiment of the present invention.

This illustration demonstrates the option of inserting a surgicalretractor 2 through one single incision and positioning it at differentangles relative to the spine for the purpose of performing severaldifferent operations. Between subsequent operations, the ribs 21 can bereplaced to be of a suitable length for each different purpose.

FIG. 25 is a side view illustration of a surgical retractor 2 at twodifferent angles, according to an embodiment of the present invention.

According to an embodiment of the present invention, the ribs 21 arecurved. This illustration demonstrates the option for performingbilateral spinal cord decompression via a single incision.

FIG. 26 is an isometric view illustration of a surgical retractor 2connected to holding arms 48, according to an embodiment of the presentinvention.

The present illustration demonstrates connection and carrying of thesurgical retractor 2 without use of an adaptor 40, (not shown in thepresent illustration).

The surgical retractor 2 according to an embodiment of the presentinvention includes cover disc holding pins 11 j, for example, three,each of which can be connected to a holding arm 48, with a clamp 47, orany other suitable device, at its end, for the purpose of connection tothe operation bed.

The holding arm 48 is an arm which can be bent and geometricallyadapted, and is capable of steadily carrying a load. This arm can becontinuous or composed of segments.

FIGS. 27 a-27 f are side view illustrations of a surgical retractor 2 atsix different stages of opening in the operated patient's body,according to an embodiment of the present invention.

All six illustrations show only two ribs 21 for each retractor 2.

FIG. 27 a shows a stage of insertion of a retractor 2, having ribs 21,with the length of each one being different from the other.

These lengths are selected according to the anatomic structure of theoperated patient.

FIG. 27 b shows a stage of linear opening, toward the left according tothe orientation of the present illustration, of the longer rib 21.

FIG. 27 c shows a stage of angular opening, clockwise according to theorientation of the present illustration, of the longer rib 21.

FIG. 27 d shows a stage of angular opening, counterclockwise accordingto the orientation of the present illustration, of the shorter rib 21.

FIG. 27 e shows a stage after replacement of the shorter rib 21 with alonger rib 21, which requires removal and subsequent reinsertion of theretractor 2.

FIG. 27 f shows an additional stage of angular opening, counterclockwiseaccording to the orientation of the present illustration, of the new rib21.

It is important to note that these stages, as shown above are not in anyway limiting the present invention, and opening can be performed in manyvarious forms and stages.

FIG. 28 is a flow chart that schematically illustrates a method ofoperation for minimal invasive (MI), bilateral symmetric decompression(BSD) of spinal stenosis (SS), in accordance with an embodiment of thepresent invention.

In the first stage of the method of operation for decompression ofspinal stenosis, a surgical retractor is inserted through the bilateralprojection of lamina vertebralis, wherein the surgical retractor hasribs and a mechanism for transferring of linear and rotational movementsof the ribs, (stage 201).

In the second stage of the method of operation for decompression ofspinal stenosis, the ribs are moving in linear movements, (stage 202).

In the third stage of the method of operation for decompression ofspinal stenosis at least one rib is moving in a rotational movement,(stage 203).

In the fourth stage of the method of operation for decompression ofspinal stenosis an incising a lamina proximal to vertebral facets isdone with a micro drill or circular micro saw, (stage 204).

In the fifth stage of the method of operation for decompression ofspinal stenosis a wedge is inserting for a distraction of bilateralvertebral lamina, (stage 205).

FIG. 29 a is an isometric top view schematic illustration of a surgicalretractor 2 according to an embodiment of the present invention.

This embodiment is simpler than the embodiment of FIG. 2 a. It includesless part, can be more lightweight, and can likewise be less expensive.As such, it can be suitable for single-time use, as a whole or themajority of its parts.

This embodiment includes the same ribs 21, for all features, asdescribed so far according to the present invention. The ribs 21 of allthe embodiments can be made of material or materials transparent tox-rays.

The channeled disc 13 and the main slider 15 of the surgical retractor 2according to FIG. 29 a embodiment differ in shape from the channeleddisc 13 and the main slider 15 of the surgical retractor 2 according toFIG. 2 a embodiment. However, in both of these embodiments, the mainsliders 15 are assembled into channeled discs 13 so as to enable linearradial movement relative to the centers channeled discs 13.

FIG. 29 b is a side view schematic illustration of the surgicalretractor 2 of FIG. 29 a according to an embodiment of the presentinvention.

The present illustration owssh ribs 21 that are all identical in shapesand dimensions, in a state following angular opening. Cchanneled disc 13is attached to a base disc 18, under which the illustration shows lamps51 b.

FIG. 30 is an exploded, isometric top view schematic illustration of thesurgical retractor 2 of FIG. 29 a, according to an embodiment of thepresent invention.

The surgical retractor 2 of FIG. 29 a includes several assemblies, themechanism for transferring of linear and rotational movements 10, theribs assembly 20, and the lighting assembly 50.

The mechanism for transferring of linear and rotational movements 10includes the main sliders 15, slider pivots 15 j, angular adjustmentbolts 14 a, linear adjustment bolts 14 b, channeled disc 13, and a basedisc 18.

The channeled disc 13 can be made of various materials, also includingvarious metals or materials transparent to x-rays, such as a plasticmaterial, and it can be designated for single-time use.

The base disc 18 is connected to the bottom of the channeled disc 13 andserves as a cover for electric wires (not shown in the presentillustration), which provide electrical power supply to lightingassembly 50, and can also be made of various materials, also includingvarious metals or materials transparent to x-rays.

Each rib 21 engages with a main slider 15 by means of a replaceableslider pivot 15 j and can be made of various materials, also includingvarious metals or materials transparent to x-rays.

Main slider 15 includes a first interior thread 15 m into which isscrewed an angular adjustment bolt 14 a, and a second interior thread 15n into which is screwed a linear adjustment bolt 14 b, by means of whichthe linear and angular opening of the ribs 21 can be adjusted.

FIG. 31 a is a side view schematic illustration of a segment of achanneled disc 13, an angular adjustment bolt 14 a, a linear adjustmentbolt 14 b, a main slider 15, a slider pivot 15 j, and a rib 21 of thesurgical retractor 2 of FIG. 29 according to an embodiment of thepresent invention.

The screwing of the angular adjustment bolt 14 a into the first interiorthread 15 m of the main slider 15 applies moment on the rib 21,resulting in its rotational movement around the slider pivot 15 jrelative to the main slider 15. Screwing the linear adjustment bolt 14 binto the second interior thread 15 n of the main slider 15 applies forceto the channeled disc 13 resulting in linear movement of the main slider15 along with the rib 21 relative to the channeled disc 13.

The shapes and sizes of the slider pivot hole 15 e, the gap between theslider pivot and the slider among arms surface d₆, the slider among armssurface 15 f, and the slider among arms surface radius r₃ as shown inFIG. 10 d also apply to the main slider 15 shown in the presentillustration.

FIG. 31 b is an isometric top view schematic illustrations of achanneled disc 13, an angular adjustment bolt 14 a, a linear adjustmentbolt 14 b, a main slider 15, and a rib 21 of the surgical retractor 2 ofFIG. 29 a, according to an embodiment of the present invention.

The present illustration shows that channel 13 k can have a lateralsection shape that is closed in all directions.

FIG. 32 a is a top view schematic illustration of the channeled disc 13of the surgical retractor 2 of FIG. 29 a, according to an embodiment ofthe present invention, upon which a section plane g-g is marked.

FIG. 32 b is a cross sectional view g-g illustrations of the channeleddisc 13 of the surgical retractor 2 of FIG. 29 a, according to anembodiment of the present invention.

The present illustration shows channeled disc wire holes 13 p, which canbe threaded with electric wire to provide electric power to the lightingsystem.

FIG. 33 is a top view schematic illustration of the surgical retractor 2of FIG. 29, according to an embodiment of the present invention, uponwhich a section plane h-h is marked.

FIG. 34 is a cross sectional view h-h illustration of the surgicalretractor 2 of FIG. 29 a, according to an embodiment of the presentinvention.

The section plane shows two ribs 21, the left one of which having alarger rib working arm length d₉. The dimensions of its rib openingangle δ and slider pivot distance from the grooved disc centralperforation center d₂₀ are also larger.

The dimensions of the rib opening angle δ and the slider pivot distancefrom the grooved disc central perforation center d₂₀ are respectivelydetermined by the extent to which the angular adjustment bolt 14 a andthe linear adjustment bolt 14 b are screwed in relative to main slider15.

The combination of dimensions given here is one private case of manypossible cases and combinations, as well as occasional replacement ofribs 21.

FIG. 35 b is a cross sectional view i-i illustrations of a main slider15 of the surgical retractor 2 of FIG. 29 a, according to an embodimentof the present invention.

The main slider 15 of the surgical retractor 2 of FIG. 29 a has threeportions, a main slider upper portion 15 p, a main slider mid portion 15q, and a main slider lower portion 15 r.

In the upper portion 15 p, there is a perforation, all or part of whichcomprises first interior thread 15 m. In the mid portion 15 q, there isa perforation, all or part of which comprises second interior thread 15n.

The three portions have an upper portion length d₂₁, a mid portionlength d₂₂, and a lower portion length d₂₃, respectively. The dimensionof the upper portion length d₂₁ r than that ofis smalle lower portionlength d₂₃, and the dimension of the mid portion length d₂₂ is smallerthan those of both. This serves the purpose of conforming the shapes anddimensions of the main slider 15 to those of other components with whichit is engaged, for smooth and efficient use.

FIG. 36 a is an isometric top view schematic illustration of a surgicalretractor 2 according to an embodiment of the present invention.

FIG. 36 b is a side view schematic illustration of the surgicalretractor 2 of FIG. 36 a, according to an embodiment of the presentinvention.

This embodiment is very similar to the embodiment of FIG. 29 a, howeveralso includes an opening mechanism first type 60 a, which facilitateslinear opening of the ribs 21, and an external disc 19 to preventundesired linear closing.

The present illustration showsthe opening mechanism first type 60 aslightly separated upwards from the other assemblies of the surgicalretractor 2. The present illustration also shows lamps 51 b.

FIG. 37 is an exploded, isometric top view schematic illustration of thesurgical retractor 2 of FIG. 36 a, according to an embodiment of thepresent invention.

The surgical retractor 2 of FIG. 36 a includes several assemblies, themechanism for transferring of linear and rotational movements 10, theribs assembly 20, the lighting assembly 50, and the opening mechanismfirst type 60 a.

The mechanism for transferring of linear and rotational movements 10includes the main sliders 15, slider pivots 15 j, angular adjustmentbolts 14 a, the channeled disc 13, and a base disc 18.

The channeled disc 13 can be made of various materials, also includingmetals or materials transparent to x-rays, such as plastic material, andcan be designated for single-time use.

The base disc 18 is attached to the bottom of the cover disc 11 andserves as a cover for electrical wires (not shown in the presentillustration), which provide electrical supply to lighting assembly 50,which can also be composed of various materials, also including metalsor materials transparent to x-rays.

Each rib 21 engages with a main slider 15 by means of a replaceableslider pivot 15 j, which can be made of various materials, alsoincluding metals or materials transparent to x-rays.

Main slider 15 includes a first interior thread 15 m, into which isscrewed an angular adjustment bolt 14 a, and by means of which theangular opening of rib 21 can be determined. The linear opening of ribs21 can be done by means of activating pushing forces, directly by anoperator's hand, in an opening direction, upon the main sliders 15.After obtaining sufficient opening, the base disc 18 is rotated into astate that prevents unwanted closing back.

An additional option for performing opening is by means the openingmechanism first type 60 a. Downward force (in the orientation of thepresent illustration) on the opening mechanism ring 64 causes openingmechanism arms 63 to activate linear opening force upon the openingmechanism sliders 64, and when these are engaged with the main sliders15, the main sliders 15 are subject to linear opening forces. Afterperformance of the linear opening, the base disc 18 is rotated to astate that prevents closing back and the opening mechanism first type 60a is removed from the area in which the medical procedure is performed.

Following is a list of possible materials that can be used for variouscomponents of the surgical retractor 2 according to the embodiments ofthe present invention. This list is in no way limiting the presentinvention to the use of any specific materials.

The channeled disc 13 and the external disc 19 can be made of nylon 6/10or polycarbonate.

The ribs 21 can be made of nylon 6/10+20%−30% carbon fiber or stainlesssteel such as stainless steel 316L.

The main slider 15 can be made from stainless steel such as stainlesssteel 316L or from brass.

The opening mechanism first type 60 a can be made from stainless steelsuch as stainless steel 316L.

FIG. 38 is a top view schematic illustration of the surgical retractor 2of FIG. 36 a, according to an embodiment of the present invention, uponwhich a section plane j-j is marked.

FIG. 39 is a cross sectional view j-j illustration of the surgicalretractor 2 of FIG. 36 a, according to an embodiment of the presentinvention.

Outward linear movement, in the present illustration leftwards, of themain slider 15, which is shown on the left in the present illustration,will result in linear opening motion of the left rib 21, as a result offorce applied by the slider pivot 15 j, which is connected to the mainslider 15.

Rotation of the linear adjustment bolt head 14 c assembled to theangular adjustment bolt 14 a in a direction that will screw it inward,will result in applying torque to the upper part of rib 21, resulting inrotational opening.

The present illustration shows that the opening mechanism first type 60a includes an opening mechanism pole 61 a, upon which is mounted anopening mechanism arms ring 62, which can move along its length.

The opening mechanism arms ring 62 is connected to opening mechanismarms 63 by means of opening mechanism arm upper pivots 63 a. The otherend of each opening mechanism arm upper pivot 63 a is connected by meansof an opening mechanism arm lower pivot 64 b to an opening mechanismslider 64 which conforms to the opening mechanism base 65, so as toenable its linear radial movement.

When an axial force F₅ is applied to the opening mechanism arms ring 62,downward movement, in the view shown in the present illustration, of theopening mechanism arms ring 62 is achieved, which is transmitted intoradial force F₆ activated upon opening mechanism slider 64. This forcecan serve to move the main slider 15 in linear outward movement.

FIG. 40 is a side view schematic illustration of an angular adjustmentbolt 14 a, a main slider 15, a slider pivot 15 j, and a rib 21, of thesurgical retractor 2 of FIG. 36 a, according to an embodiment of thepresent invention.

Screwing the angular adjustment bolt 14 a into the first interior thread15 m of the main slider 15 causes the activation of moment upon the rib21, resulting in rotational movement of rib 21 around the slider pivot15 j relative to the main slider 15.

The shapes and dimensions of the slider pivot hole 15 e, the gap betweenthe slider pivot and the slider among arms surface d₆, the slider amongarms surface 15 f, and the slider among arms surface radius r₃, asdescribed in FIG. 10 d also apply to the main slider 15 shown in thepresent illustration.

FIG. 41 is an isometric top view schematic illustration of a main slider15, and an opening mechanism slider 64 of the surgical retractor 2 ofFIG. 36 a, according to an embodiment of the present invention.

The opening mechanism slider 64, during the execution of linear opening,activates radial force F₆, upon the main slider 15, in the direction ofthe arrow shown in the present illustration.

FIG. 42 is an isometric top view schematic illustration of a main slider15, and a segment of the external disc 19 of the surgical retractor 2 ofFIG. 36 a, according to an embodiment of the present invention.

External disc 19 includes, for every main slider 15, an external discstair 19 h which after linear opening and after the rotation of theexternal disc 19 to the desired state prevents the main slider 15 frommoving back in the direction of linear closing. The external disc 19,shown in the present illustration, includes for each main slider 15, oneexternal disc stair 19 h designated for it, however there is noprevention, according to the present invention, from including more thanone external disc stair 19 h for each main slider 15 in the externaldisc 19, so as to be suitable for various degrees of linear opening.

Upon completion of the surgical procedure, the external disc 19 can berotated back so that the external disc stairs 19 h do not prevent linearmovement in a closing direction of the sliders 15. In this state, as aresult of the pressure of the body tissue in the area of the procedure,and the pressure of the flexible sleeve 23, if it is assembled, the ribs21 (not shown in the present illustration) close, namely they drawcloser to each other, thus facilitating their removal from the patient'sbody.

FIG. 43 is an exploded, isometric top view schematic illustration of theopening mechanism first type 60 a of the surgical retractor 2 of FIG. 36a, according to an embodiment of the present invention.

The opening mechanism arms ring 62 has an opening mechanism arms ringcentral hole 62 a, which grants it the ability to move along the lengthof the opening mechanism pole 61 a, when the opening mechanism pole 61 ais engaged within the opening mechanism arms ring central hole 62 a.Furthermore, the opening mechanism arms ring 62 is equipped with pairsof opening mechanism arms ring arms 62 b, each pair being connected, bymeans of an opening mechanism arm upper pivot 62 a, to an openingmechanism arm 63, near one of its ends. Near its other end, the openingmechanism arm 63 is connected, by means of an opening mechanism armlower pivot 63 b, to an opening mechanism slider 64.

The opening mechanism arm 63 has ability for rotational movementrelative to opening mechanism arm upper pivot 62 a and to an openingmechanism arm lower pivot 63 b.

The opening mechanism base 65 has an opening mechanism base hole 65 a,which serves for its connection to the opening mechanism pole 61 a.

The opening mechanism base 65 includes opening mechanism base grooves 65b, each of which serves to enable and guide movement within and alongopening mechanism slider 64.

Both sides of opening mechanism base groove 65 b have two openingmechanism base tracks 65 c.

The opening mechanism slider 64 has an external shape and dimensionsthat are suitable to receive force by means of an opening mechanism armlower pivot 63 b from an opening mechanism arm 63, in order to performlinear movement within an opening mechanism base groove 65 b upon a pairof opening mechanism base tracks 65 c, and in order to transmit force toa main slider 15, (not shown in the present illustration).

This external shape also includes an opening mechanism slider upperchannel 64 a, an opening mechanism slider bottom channel 64 b, twoopening mechanism slider side channels 64 c, and an 64 d openingmechanism slider pushing portion.

All of the features of the ribs 21, the flexible sleeve 23 and thecentral rod 30 as shown in FIGS. 2 a-2 c, 3 b, 7 a, 10 a , 10 e-10 h,11, 12 a-12 c, 13 a-13 c, 14 a-14 h, 18 a-18 f, 20-25, 27 a-27 f, and28, and their accompanying descriptions, also apply to their use in thesurgical retractors 2, of FIGS. 36 a and 29 a.

FIG. 44 a is an exploded, isometric top view schematic illustration ofthe opening mechanism second type 60 b of the surgical retractor 2 ofFIG. 36 a, according to an embodiment of the present invention.

The opening mechanism second type 60 b operates in a similar manner tothat of the opening mechanism first type 60 a (not shown in the presentillustration), however it is constructed so as to enable the surgeon toview through its center when opening. For this purpose, an openingmechanism cylinder 61 b replaces the opening mechanism pole 61 a, (notshown in the present illustration).

The opening mechanism cylinder 61 b has an opening mechanism cylinderinternal diameter 61D of a predetermined minimum value which ensures asufficiently large visual range. On the external side of the openingmechanism cylinder 61 b there is an opening mechanism cylinder externalthread 61 ba. The opening force is transmitted manually or by means ofan engine, (not shown in the present invention), to opening mechanismnut 66, which in turn presses on the opening mechanism arms ring 62.

The opening mechanism arms ring central hole 62 a is large enough, andconforms to the external dimensions of the opening mechanism cylinder 61b.

The opening mechanism nut 66 includes an opening mechanism nut body 66 acontaining an opening mechanism nut internal thread 66 b, which conformsto opening mechanism cylinder external thread 61 ba.

FIG. 44 b is an isometric top view schematic illustration of the openingmechanism second type 60 b of the surgical retractor 2 of FIG. 36 a,according to an embodiment of the present invention.

Both the opening mechanism first type and opening mechanism second typecan also be composed of various materials, also including metals,plastics, and materials transparent to x-rays.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims.

1. A surgical retractor, comprising: (a) a ribs assembly; (b) amechanism for transferring of linear and rotational movement adapted toapply mechanical forces and moments to said ribs assembly; and (c) achanneled disc wherein said mechanism for transferring of linear androtational movement and said ribs assembly are mounted on said channeleddisc.
 2. The surgical retractor of claim 1, wherein said channeled discis made of material selected from a group consisting of nylon andpolycarbonate.
 3. The surgical retractor of claim 2, wherein said ribsassembly includes: (i) at least two ribs, wherein each one of said ribshas a rib force arm and a rib working arm disposed on said rib forcearm, wherein said rib has a rib back surface, a rib front surface, a ribtop end, a rib bottom end, and a rib shoulder, wherein said rib shoulderis disposed on said force arm, wherein said rib force arm has a ribforce arm length and a rib force arm width, wherein said rib force armwidth tapers toward said rib top end, wherein said rib working arm has arib working arm length and a rib working arm width, wherein said ribworking arm width tapers toward said rib bottom end, and wherein saidrib has a concave segment of a rib front surface said concave segment ofa rib front surface having a concave segment of a rib front surfacediameter.
 4. The surgical retractor of claim 3, wherein said ribs aremade of material containing nylon and carbon fibers.
 5. The surgicalretractor of claim 3, wherein said ribs are made of stainless steel. 6.The surgical retractor of claim 3, wherein at least one of said ribworking arm lengths is larger than at least another one of said ribworking arm length.
 7. The surgical retractor of claim 3, wherein saidchanneled disc includes: (i) at least two channels.
 8. The surgicalretractor of claim 7 wherein said mechanism for transferring of linearand rotational movement includes: (i) at least two main sliders, whereineach one of said main sliders has a main slider upper portion having anupper portion length, a main slider mid portion, having a mid portionlength wherein said main slider mid portion is disposed on said mainslider upper portion, and a main slider lower portion, having a lowerportion length, wherein said main slider lower portion is disposed onsaid main slider mid portion, wherein said upper portion length islarger than said mid portion length, wherein said lower portion lengthis larger than said upper portion length, and wherein each of said mainslider lower portions is partially mounted inside one of said channels.9. The surgical retractor of claim 8 wherein each of said main slidersincludes: a pair of slider arms disposed on said main slider lowerportion; and a slider pivot disposed on said pair of slider arms,wherein said main slider lower portion has a slider among arms surfaceand wherein there is a gap between the slider pivot and the slider amongarms surface having a predetermined dimension value, and wherein saidslider pivot is adapted for transferring force to said concave segmentof a rib front surface.
 10. The surgical retractor of claim 9 whereinsaid main slider has a first interior thread located in said main sliderupper portion.
 11. The surgical retractor of claim 10 wherein saidmechanism for transferring of linear and rotational movement furtherincludes: (ii) at least two angular adjustment bolts wherein each one ofsaid angular adjustment bolts is mounted inside said one of said firstinterior thread and is adapted for transferring force to one of said ribforce arms.
 12. The surgical retractor of claim 11 wherein said mainslider has a second interior thread located in said main slider midportion.
 13. The surgical retractor of claim 12 wherein said mechanismfor transferring of linear and rotational movement further includes:(ii) at least two linear adjustment bolts wherein each of said linearadjustment bolts is mounted inside one of said second interior threads.14. The surgical retractor of claim 11 further comprising: (d). anopening mechanism first type, wherein said opening mechanism first typeis adapted for engaging to said main sliders for performing linearopening and wherein said opening mechanism first type is adapted forremoving from said main sliders at an operation stage.
 15. The surgicalretractor of claim 14 wherein said opening mechanism first typeincludes: (i) an opening mechanism base having at least two openingmechanism base grooves, and at least four opening mechanism base tracks;(ii) an opening mechanism pole disposed on said opening mechanism base;(iii) an opening mechanism arms ring, having at least two pairs ofopening mechanism arms ring arms, wherein said opening mechanism armsring has an opening mechanism arms ring central hole, and wherein saidopening mechanism arms ring is mounted on said opening mechanism pole;(iv) at least two opening mechanism arms; (v) at least two openingmechanism sliders; (vi) at least four opening mechanism arm upperpivots; and (vii) at least four opening mechanism arm lower pivots,wherein each one of said opening mechanism arm upper pivot is disposedon one of said pairs of opening mechanism arms ring arms, wherein eachone of said opening mechanism arm lower pivots is disposed on one ofsaid opening mechanism sliders, and wherein said each one of saidopening mechanism arms is mounted on said opening mechanism arm upperpivot and on one of said opening mechanism arm lower pivots.
 16. Thesurgical retractor of claim 15 wherein each one of said openingmechanism sliders includes: an opening mechanism slider upper channel,adapted for enabling a rotational movement of one of said openingmechanism arms; an opening mechanism slider bottom channel adapted forengaging to one of said main sliders; two opening mechanism slider sidechannels, wherein each one of said opening mechanism slider sidechannels is adapted for enabling a linear movement of one of said mainsliders on one of said opening mechanism base tracks; and an openingmechanism slider pushing portion adapted for transferring force to oneof said main sliders.
 17. The surgical retractor of claim 11 furthercomprising: (d). an opening mechanism second type, wherein said openingmechanism second type is adapted for engaging to said main sliders forperforming linear opening and wherein said opening mechanism first typeis adapted for removing from said main sliders at an operation stage.18. The surgical retractor of claim 14 wherein said opening mechanismsecond type includes: (i) an opening mechanism base having at least twoopening mechanism base grooves, and at least four opening mechanism basetracks; (ii) an opening mechanism cylinder disposed on said openingmechanism base, wherein said has and opening mechanism cylinder externalthread and an opening mechanism cylinder internal diameter; (iii) anopening mechanism nut mounted on said opening mechanism cylinder,wherein said opening mechanism cylinder has an opening mechanism nutinternal thread; (iv) an opening mechanism arms ring, having at leasttwo pairs of opening mechanism arms ring arms, wherein said openingmechanism arms ring has an opening mechanism arms ring central hole, andwherein said opening mechanism arms ring is mounted on said openingmechanism cylinder; (v) at least two opening mechanism arms; (vi) atleast two opening mechanism sliders; (vii) at least four openingmechanism arm upper pivots; and (viii) at least four opening mechanismarm lower pivots, wherein each one of said opening mechanism arm upperpivot is disposed on one of said pairs of opening mechanism arms ringarms, wherein each one of said opening mechanism arm lower pivots isdisposed on one of said opening mechanism sliders, and wherein said eachone of said opening mechanism arms is mounted on said opening mechanismarm upper pivot and on one of said opening mechanism arm lower pivots.19. The surgical retractor of claim 15 wherein each one of said openingmechanism sliders includes: an opening mechanism slider upper channel,adapted for enabling a rotational movement of one of said openingmechanism arms; an opening mechanism slider bottom channel adapted forengaging to one of said main sliders; two opening mechanism slider sidechannels, wherein each one of said opening mechanism slider sidechannels is adapted for enabling a linear movement of one of said mainsliders on one of said opening mechanism base tracks; and an openingmechanism slider pushing portion adapted for transmitting force to oneof said main sliders.
 20. The surgical retractor of claim 14 furthercomprising: (e) an external disc having at least two external discstairs, wherein said external disc is mounted on said channeled disc andpartially between each of said main sliders said main slider upperportion and said main slider lower portion, wherein said external discis adapted for rotational movement around said channeled disc, andwherein said external disc stairs are adapted for preventing said mainsliders from movement.
 21. The surgical retractor of claim 13, furthercomprising: (d) a lighting assembly disposed on said channeled disc. 22.The surgical retractor of claim 17, further comprising: (d) a lightingassembly disposed on said channeled disc.
 23. A method of minimallyinvasive operation for decompression of spinal stenosis, the methodcomprising the stages of: (a) inserting a surgical retractor through abilateral projection of first bilateral vertebral lamina, wherein saidsurgical retractor has ribs, a mechanism for transferring of linear androtational movements to said ribs, and a channeled disc, wherein saidchanneled disc is made of material selected from a group consisting ofnylon and polycarbonate; (b) moving said ribs in linear movements; (c)moving at least one of said ribs in a rotational movement; (e) incisinga first lamina; (f) inserting a wedge for distraction of said firstbilateral vertebral lamina; and (e) replacing at least one of said ribs.